Response–Guided Axillary Treatment of Node-Positive Breast Cancer: The MARI Protocol

Clinical Takeaway

: In patients with limited nodal disease, post-MARI risk for axillary recurrence was very low.

Context

The quest to de-escalate therapy for breast cancer has prompted tailored axillary lymph node dissection, modified radiation therapy (RT) protocols, and fewer mastectomies; but do these less-intense treatments raise recurrence risk, thereby compromising survival? Investigators in the Netherlands pursued the “marking the axillary lymph node with a radioactive seed” (MARI) protocol in patients with operable breast cancer and node-positive disease. Those who attained a pathologic complete response (pCR) in the MARI node following primary systemic treatment (PST) received no further axillary treatment, while those with residual disease received RT including the axilla. Patients undergoing breast-conserving surgery (BCS) received RT to the…

Reviewing Author

William Gradishar, MD

Disclosures

Consultant/Advisory BoardLilly; AstraZeneca; Gilead

Grant/Research SupportBreast Cancer Research Foundation

Editorial BoardsClinical Breast Cancer; Oncology; Annals of Surgery; Breast Cancer Research and Treatment

Leadership Positions in Professional SocietiesNational Comprehensive Cancer Network (Chair, Breast Cancer Panel); American Board of Internal Medicine (Medical Oncology Board)