Sentinel Lymph Node Biopsy After Neoadjuvant Oncological Treatment in Luminal B, HER-2 Positive and Triple Negative Breast Cancer Patients in Stage T1-3 N0-2 M0 at the Time of Diagnose
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 230
- 试验地点
- 1
- 主要终点
- Correlation of sentinel node negative patients from group 3 and disease progression free survival
研究概览
简要总结
This clinical trial is designed as an observational study of 8-9 years of overall duration, but the first results and conclusions could be achieved in 3-4 years. In the first phase, which would last 3-4 years, the investigators will form three predetermined groups of breast cancer patients that would be monitored in the second phase for 5 postoperative years.
All patients involved in this trial would undergo a defined protocol. All patients participating in this trial and all members of the investigation team would be completely introduced to the plan and aims of this trial.
Two main hypotheses of this trial are that SLNB does not have a negative impact on clinical outcomes (locoregional recurrence and overall survival) in initially node-positive patients who achieved complete clinically axillary remission after neoadjuvant systemic treatment and that lymph node status after neoadjuvant treatment is a significantly more relevant prognostic factor than nodal status at the time of diagnosis.
Therefore, the aim is to establish that sentinel lymph node biopsy, in node-positive breast cancer patients that achieve clinical remission after neoadjuvant treatment, is a reliable approach for surgical axillary management.
Data would be collected individually for each patient and recorded on appropriate forms. After data completion, the principal investigator would import encoded data into the register. Data collected in this trial would be used for publications.
详细描述
This clinical trial is designed as a prospective, observational, non-randomized clinical trial of 8-9 years of overall duration, but the first results and conclusions (secondary outcomes) could be achieved in 3-4 years from the beginning of the study.
Based on ultrasound and/or magnetic resonance assessment of primary tumour dimensions, pathological report of core needle biopsy, ultrasound evaluation of axillary lymph nodes and cytologically proven positive lymph nodes, patients would be divided into three predefined groups and would undergo predetermined group protocol.
Group 1 (T1-2 N0 M0) protocol: Surgery is primary treatment (quadrantectomy/mastectomy and sentinel lymph node biopsy).
Group 2 (T2-3 N0 M0) protocol: Neoadjuvant oncological treatment is primary therapy followed by surgery (quadrantectomy/mastectomy and sentinel lymph node biopsy) and afterwards by adjuvant oncological treatment. Before neoadjuvant treatment, all patients would undergo magnetic resonance (MR) imaging and ultrasound-guided placement titanium clip in the primary tumour site. Clinical assessment of the effectiveness of neoadjuvant treatment would be evaluated by breast MR imaging in the middle and at the end of the neoadjuvant systemic treatment.
Group 3 (T1-3 N1-2 M0) protocol includes the Group 2 protocol in addition to FNA (cytology) proof of positive node, ultrasound-guided marking positive node with titanium clip before starting neoadjuvant protocol, ultrasound and MR imaging reevaluation of axillary nodes at the end of neoadjuvant treatment and for those patients who achieve complete clinical remission of axillary lymph nodes, biopsy of marked node would be performed in context of standard surgical procedure (in addition to quadrantectomy/mastectomy and sentinel lymph node biopsy) regardless being sentinel node or not.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Patients must be female
- •Patients must be older than 18 years of age and younger than 80 years of age
- •Patients must have biopsy-proven breast cancer, histological type-ductal, immunophenotype-Luminal B, HER-2 positive and triple-negative
- •Patients with nodal disease (N1-N2) must have fine needle aspiration proven positive node and marked node with titanium clip before onset of neoadjuvant treatment
- •Patients treated (oncological and surgical) in Clinical Hospital Centar Rijeka from September 2018 till May 2022
- •Patients must be in stage cT1-3 cN0-2 cM0 at the time of diagnosis and cN0 at the time of the surgery
- •Patients that are eligible for neoadjuvant oncological treatment, accepting to undergo it and complete it
- •Patients who understand, accept and have signed the approved consent form
排除标准
- •Patents in T4 stage and/or N3 stage and/or M1 stage at the time of diagnosis
- •Patients with inflammatory carcinoma
- •Patients with bilateral disease
- •Patients with ipsilateral recurrence
- •Patients with histological type-lobular and immunophenotype-Luminal A
- •Patients that are not eligible for oncological treatment according to protocol, either neoadjuvant or adjuvant, or oncological treatment was interrupted (aborted or completed in another institution)
- •Patients that have had previously SLNB or ALND or radiotherapy to the axillary nodes
- •Patients that have been or are treated for other malignant disease
- •Patients with hypersensitivity or allergy to radiocolloid
- •Patients without complete documentation required for this study
- •Pregnant patients
- •Psychiatric patients
- •Male patients
结局指标
主要结局
Correlation of sentinel node negative patients from group 3 and disease progression free survival
时间窗: 5 postoperative years
Disease progression free survival from sentinel node negative patients from group 3 compared to disease progression free survival from sentinel node positive patients from group 3 and disease progression free survival from patients from group 3 that did not achieve complete clinical axillary remission. Disease progression free survival for group 3 sentinel node negative patients compared to group 1 and 2 and to our former data (patients of same stage at diagnosis treated without neoadjuvant systemic therapy)
Correlation of sentinel node negative patients from group 3 patients and overall survival
时间窗: 5 postoperative years
Overall survival from sentinel node negative patients from group 3 compared to overall survival from sentinel node positive patients from group 3 and overall survival from patients from group 3 that did not achieve complete clinical axillary remission. Overall survival for group 3 sentinel node negative patients compared to group 1 and 2 and to our former data (patients of same stage at diagnosis treated without neoadjuvant systemic therapy)
Impact of sentinel lymph node biopsy procedure on locoregional recurrence for group 3 sentinel node negative patients
时间窗: 5 postoperative years
Locoregional recurrence for group 3 sentinel node negative patients compared to group 1 and 2, to our former (hystorical) data and literature data
次要结局
- Evaluate the correlations of axillary response to neoadjuvant treatment and pathological characteristic of tumor(4 years)
- Evaluate accuracy of standard breast MR imaging in axillary lymph node evaluation after neoadjuvant treatment (overall and related to tumor subtypes)(4 years)
研究者
Ana Car Peterko
general surgeon, surgical oncologist, FEBS, CEBS
Clinical Hospital Center Rijeka