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<p>Adjuvant studies have shown that even with 1–2 sentinel metastases axillary lymph node dissection (ALND) can be avoided if breast-conserving surgery or mastectomy is performed with concomitant radiotherapy; however, the necessary target volumes for radiotherapy are still not clearly defined. Current study data already enable the complete avoidance of axillary surgery in hormone receptor-positive tumors with a&#xa0;low risk profile while maintaining the same oncological safety. The only thing to be considered is the consequence of an unknown axillary lymph node status with respect to further adjuvant therapy options that could arise, e.g., for the use of cyclin-dependent kinase (CDK) 4/6 or poly(ADP-ribose) polymerase (PARP) inhibitors. The possibility to avoid ALND also exists in the neoadjuvant setting. Even if isolated tumor cells and micrometastases are detected ALND is no longer generally recommended.</p>

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Aktuelle Entwicklungen im axillären Management beim primären Mammakarzinom

  • 期刊论文

  • 发表日期：

    2026年1月26日

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  • N. Rohrmoser,
  • M. B. Köpke,
  • M. Schneider,
  • H. Kahl,
  • M. Langenbach,
  • Nina Ditsch

摘要

Adjuvant studies have shown that even with 1–2 sentinel metastases axillary lymph node dissection (ALND) can be avoided if breast-conserving surgery or mastectomy is performed with concomitant radiotherapy; however, the necessary target volumes for radiotherapy are still not clearly defined. Current study data already enable the complete avoidance of axillary surgery in hormone receptor-positive tumors with a low risk profile while maintaining the same oncological safety. The only thing to be considered is the consequence of an unknown axillary lymph node status with respect to further adjuvant therapy options that could arise, e.g., for the use of cyclin-dependent kinase (CDK) 4/6 or poly(ADP-ribose) polymerase (PARP) inhibitors. The possibility to avoid ALND also exists in the neoadjuvant setting. Even if isolated tumor cells and micrometastases are detected ALND is no longer generally recommended.