St. Gallen 2009 recommendations on the treatment of early breast cancer: consensus and controversy

The 11th St. Gallen consensus meeting on the primary treatment of early breast cancer put a special emphasis on a tailored approach for patient subgroups, and by the selection of targetted treatments according to tumour biology. Sentinel node procedure was considered as the standard in invasive breast cancer with no clinical evidence of lymph node involvement. Concerning ductal carcinoma in situ (DCIS), the panellists voted for adjuvant radiotherapy to be considered standard for excised DCIS, but irradiation might be avoided in the elderly and in patients with low-grade DCIS. Accelerated whole breast radiotherapy was considered an acceptable optional after tumour excision, especially in patients above the age of 60 years. Furthermore, the panel supported validated multigene assays to be considered as an additional tool for choosing chemotherapy in endocrine-responsive disease. Concerning endocrine treatment, the panellists preferred up-front endocrine therapy with an aromatase inhibitor on the basis of the updated results of BIG 1-98, especially for cases with high risk of early recurrence. Changing the aromatase inhibitor to tamoxifen after 2 years of treatment was accepted as a treatment option. Finally, dose-dense doxorubicin/cyclophosphamide chemotherapy followed by paclitaxel, and docetaxel/cyclophosphamide were added to the group of standard adjuvant regimens.