Reply to ‘The St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017: the point of view of an International Panel of Experts in Radiation Oncology’ by Kirova et al.
Authors: P. Dubsky, G. Curigliano, H.J. Burstein, E.P. Winer, M. Gnant, S. Loibl, M. Colleoni, M.M. Regan, M. Piccart-Gebhart, H.-J. Senn, B. Thürlimann, F. André, J. Baselga, J. Bergh, H. Bonnefoi, S.Y. Brucker, F. Cardoso, L. Carey, E. Ciruelos, J. Cuzick, C. Denkert, A. Di Leo, B. Ejlertsen, P. Francis, V. Galimberti, J. Garber, B. Gulluoglu, P. Goodwin, N. Harbeck, D.F. Hayes, C.-S. Huang, J. Huober, H. Khaled, J. Jassem, Z. Jiang, P. Karlsson, M. Morrow, R. Orecchia, K.C. Osborne, O. Pagani, A.H. Partridge, K. Pritchard, J. Ro, E.J.T. Rutgers, F. Sedlmayer, V. Semiglazov, Z. Shao, I. Smith, M. Toi, A. Tutt, G. Viale, T. Watanabe, T.J. Whelan, B. Xu
Journal: Annals of Oncology (2017)

The St Gallen Writing Committee on behalf of the St Gallen Panel thanks the authors for their letter [1.Kirova Y.M. Carroll S. Fourquet A. et al.The St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017: the point of view of an International Panel of Experts in Radiation Oncology.Ann Oncol. 2018; 29: 280-281Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar]. The St Gallen Consensus process is built upon the collective recommendations from a multidisciplinary, international panel of breast cancer experts, including radiation/clinical oncologists. The goal is to recommend standard approaches to breast cancer management based on the integration of data from clinical trials and other types of evidence including subset analyses, and outcomes from biologically determined subtypes of breast cancer with experiences drawn from contemporary practice including innovations in surgery, radiotherapy, and systemic treatment. We note that the recent AJCC staging revisions also now integrate traditional stage distribution with biologically determined breast cancer subtypes for most appropriately gauging clinical risk. The St Gallen Panel provides consensus [2.Curigliano G. Burstein H.J. Winer E.P. et al.De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017.Ann Oncol. 2017; 28: 1700-1712Abstract Full Text Full Text PDF PubMed Scopus (681) Google Scholar] on many controversial areas but does not adhere to a process prerequisite for broad guidelines. Based on such considerations, and fully cognizant of the data referred to by the letter writers, the multidisciplinary Panel confirmed that postmastectomy radiotherapy and that regional nodal irradiation might be safely avoided in selected node-positive patients with N1 axillary involvement and a tumour with a favourable biological and clinical profile. This represents an opportunity to tailor treatment more effectively for women with breast cancer. The Panel also reviewed and discussed the increase of reconstructive surgery and the impact of these quickly developing techniques (including skin sparing types of mastectomy) and technologies on delivering postoperative radiation therapy and cancer outcomes. We would like to emphasize that the goal is not to compromise adjuvant therapies simply to achieve less surgery or better reconstruction. However, the general opinion at the consensus meeting was that the current evidence and clinical expertise does allow to 'de-escalate' treatment in many women. Therefore, making individualized choices well in line with evidence-based medicine should be an option for early stage breast cancer patients. None declared.