Open Access

Walter P. Weber, Oreste Davide Gentilini, Monica Morrow, Giacomo Montagna, Jana de Boniface, Florian Fitzal, Lynda Wyld, Isabel T. Rubio, Zoltan Matrai, Tari A. King, Ramon Saccilotto, Viviana Galimberti, Nadia Maggi, Mariacarla Andreozzi, Virgilio Sacchini, Liliana Castrezana López, Julie Loesch, Fabienne D. Schwab, Ruth Eller, Martin Heidinger, Martin Haug, Christian Kurzeder, Rosa Di Micco, Maggie Banys-Paluchowski, Nina Ditsch, Yves Harder, Régis R. Paulinelli, Cicero Urban, John Benson, Vesna Bjelic-Radisic, Shelley Potter, Michael Knauer, Marc Thill, Marie-Jeanne Vrancken Peeters, Sherko Kuemmel, Joerg Heil, Bahadir M. Gulluoglu, Christoph Tausch, Ursula Ganz-Blaettler, Jane Shaw, Peter Dubsky, Philip Poortmans, Orit Kaidar-Person, Thorsten Kühn, Michael Gnant

• The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the mostThe aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, followed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a prospective register.…