{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:06:06Z","timestamp":1792641966512,"version":"4.5.0"},"reference-count":54,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Breast Cancer Res Treat"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>In clinically node-positive (cN+) breast cancer patients, evidence supporting response-guided treatment after neoadjuvant systemic therapy (NST) instead of axillary lymph node dissection (ALND) is increasing, but follow-up results are lacking. We assessed three-year axillary recurrence-free interval (aRFI) in cN+\u2009patients with response-adjusted axillary treatment according to the \u2018Marking Axillary lymph nodes with Radioactive Iodine seeds\u2019 (MARI)-protocol.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We retrospectively assessed all stage II\u2013III cytologically proven cN+\u2009breast cancer patients who underwent the MARI-protocol between July 2014 and November 2018. Pre-NST axillary staging with FDG-PET\/CT (less- or more than four suspicious axillary nodes; cALN\u2009&lt;\u20094 or cALN\u2009\u2265\u20094) and post-NST pathological axillary response measured in the pre-NST largest tumor-positive axillary lymph node marked with an iodine seed (MARI-node; ypMARI-neg or ypMARI-pos) determined axillary treatment: no further treatment (cALN\u2009&lt;\u20094, ypMARI-neg), axillary radiotherapy (ART) (cALN\u2009&lt;\u20094, ypMARI-pos and cALN\u2009\u2265\u20094, ypMARI-neg) or ALND plus ART (cALN\u2009\u2265\u20094, ypMARI-pos).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 272 women included, the MARI-node was tumor-negative in 56 (32%)\u00a0of 174 cALN\u2009&lt;\u20094 patients and 43 (44%)\u00a0of 98 cALN\u2009\u2265\u20094 patients. According to protocol, 56 (21%) patients received no further axillary treatment, 161 (59%) received ART and 55 (20%) received ALND plus ART. Median follow-up was 3.0\u00a0years (IQR 1.9\u20134.1). Five patients (one no further treatment, four ART) had axillary metastases. Three-year aRFI was 98% (95% CI 96\u2013100). The overall recurrence risk remained highest for patients with ALND (HR 4.36; 95% CI 0.95\u201320.04, <jats:italic>p<\/jats:italic>\u2009=\u20090.059).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>De-escalation of axillary treatment according to the MARI-protocol prevented ALND in 80% of cN+\u2009patients with an excellent three-year aRFI of 98%.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10549-022-06545-z","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T13:04:19Z","timestamp":1646312659000},"page":"37-48","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Three-year follow-up of de-escalated axillary treatment after neoadjuvant systemic therapy in clinically node-positive breast cancer: the MARI-protocol"],"prefix":"10.1007","volume":"193","author":[{"given":"Ariane A.","family":"van Loevezijn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke E. 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All other authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The institutional review board of the Netherlands Cancer Institute approved this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This study was conducted retrospectively from data obtained for clinical purposes. 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