Omission of Axillary Lymph Node Dissection in Breast Cancer Patients With Axillary Pathological Complete Response After Neoadjuvant Systemic Therapy
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 92
- 试验地点
- 1
- 主要终点
- iDFS: invasive Disease-Free Survival after breast surgery
研究概览
简要总结
This prospective, single-arm, phase II trial studies axillary lymph node dissection (ALND) to see if it can be safely omitted in breast cancer patients with axillary pathological complete response (pCR) after neoadjuvant systemic therapy (NST). Breast cancer patients with biopsy-proven positive axillary lymph nodes at initial diagnosis, and converted to negative after NST, which is confirmed by Stained region Lymph Node Biopsy(SrLNB), will be enrolled in the study. In other words, a total of 92 patients will be exempted from ALND after SrLNB, and afterwards complete regional node irradiation (RNI) including the axilla. They will also undergo adjuvant chemotherapy, targeted therapy, endocrinotherapy after surgery. These patients will be followed up in the next three years for local-regional recurrence and long-time survival outcome.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 70 Years（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Female aged between 18 and 70 years;
- •Pathologically confirmed invasive breast cancer (regardless of pathological type) with a clinical stage cT1-3;
- •Pathologically confirmed positive axillary lymph nodes with a clinical stage of N1-3;
- •Receiving a full course of neoadjuvant therapy (including neoadjuvant chemotherapy, neoadjuvant targeted therapy, neoadjuvant immunotherapy);
- •Positive axillary lymph nodes successfully stained by carbon nanoparticles injection;
- •All patients are required to undergo immunohistochemical staining for Estrogen Receptor (ER), Progesterone Receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki- 67 proliferation index, and further fluorescence in situ hybridization (FISH) should be performed in HER2 2+ cases;
- •Preoperative clinical assessment (including physical examination, imaging, with or without nomogram assessment) suggests positive axillary lymph nodes converted to negative (ycN0);
- •ECOG score 0 - 1;
- •Patients voluntarily participated in this study and signed the informed consent form
排除标准
- •Bilateral breast cancer;
- •Breast cancer during lactation period or pregnancy;
- •Physical examination or imaging examination confirmed presence of distant metastases;
- •Previous history of malignant tumor;
- •History of previous surgery on the affected axilla; or history of surgery affecting the function of the upper extremity;
- •History of radiation therapy to the breast or chest;
- •Positive incision margins for breast-conserving surgery/mastectomy;
- •Positive results of intraoperative rapid freeze pathology (including isolated tumor cells and micrometastases) for SrLNB (ypN+);
- •Those who unable to complete the full course of follow-up adjuvant therapy as prescribed for various reasons;
- •Aspartate transaminase (AST) and alanine transaminase (ALT) ≥ 1.5 times the upper limit of normal, alkaline phosphatase（ALP） ≥ 2.5 times the upper limit of normal, total bile ≥ 1.5 times the upper limit of normal, serum creatinine ≥ 1.5 times the upper limit of normal; Left Ventricular Ejection Fractions (LVEF) < 50% in cardiac ultrasound;
- •Severe coagulation dysfunction, serious systemic disease, or uncontrolled infection;
- •Without personal freedom and independent civil capacity;
- •Those with mental disorders, addictions, who were not eligible for enrollment in the judgment of the investigator.
结局指标
主要结局
iDFS: invasive Disease-Free Survival after breast surgery
时间窗: Up to 3 years after surgery
Time interval from the surgery to invasive local-regional recurrence, distant metastasis, contralateral invasive breast cancer, or death from any cause.
次要结局
- LRR: Local-Regional Recurrence after breast surgery(Up to 3 years after surgery)
- BCRL: Breast Cancer Related Lymphedema(Up to 3 years after surgery)
- Quality of life (QoL)(Up to 3 years after surgery)
- Patient-reported arm morbidity(Up to 3 years after surgery)
研究者
Jue Wang
Prof.
The First Affiliated Hospital with Nanjing Medical University