Omission of Axillary Dissection According to ACOSOG Z0011: Impact on Adjuvant Treatment Recommendations

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• 作者：Julia Aigner (1) (2)
  Katharina Smetanay (1) (2)
  Holger Hof PhD (3)
  Hans-Peter Sinn (4)
  Christof Sohn (1)
  Andreas Schneeweiss (1) (2)
  Frederik Marmé (1) (2)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2013
• 出版时间：May 2013
• 年：2013
• 卷：20
• 期：5
• 页码：1538-1544
• 全文大小：298KB
• 参考文献：1. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. / Lancet / Oncol. 2010;11:927-3. CrossRef
  2. Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. / Lancet / Oncol. 2007;8:881-. CrossRef
  3. Giuliano AE, Haigh PI, Brennan MB, et al. Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. / J Clin Oncol. 2000;18:2553-.
  4. Yi M, Giordano SH, Meric-Bernstam F, et al. Trends in and outcomes from sentinel lymph node biopsy (SLNB) alone vs. SLNB with axillary lymph node dissection for node-positive breast cancer patients: experience from the SEER database. / Ann Surg Oncol. 2010;17(Suppl 3):343-1. CrossRef
  5. Moebus V, Jackisch C, Lueck HJ, et al. Intense dose-dense sequential chemotherapy with epirubicin, paclitaxel, and cyclophosphamide compared with conventionally scheduled chemotherapy in high-risk primary breast cancer: mature results of an AGO phase III study. / J Clin Oncol. 2010;28:2874-0. CrossRef
  6. Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes–dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. / Ann Oncol. 2011;22:1736-7. CrossRef
  7. Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. / Ann Surg. 2010;252:426-2; discussion 432-.
  8. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs. no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. / JAMA. 2011;305:569-5. CrossRef
  9. AGO_Breast_Commission. Diagnosis and treatment of patients with primary and metastatic breast cancer. In version 1 2012 Edition. http://www.ago-online.de: 2012.
  10. NCCN. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)^? Version I.2012. In version I.2012 Edition. http://www.NCCN.org: 2012.
  11. Fisher B, Jeong JH, Anderson S, et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. / N Engl J Med. 2002;347:567-5. CrossRef
  12. Veronesi U, Orecchia R, Zurrida S, et al. Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy. Ann Oncol. 2005;16:383-. CrossRef
  13. Citron ML, Berry DA, Cirrincione C, et al. Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. / J Clin Oncol. 2003;21:1431-. CrossRef
  14. Berry DA, Cirrincione C, Henderson IC, et al. Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. / JAMA. 2006;295:1658-7. CrossRef
  15. Wasif N, Maggard MA, Ko CY, Giuliano AE. Underuse of axillary dissection for the management of sentinel node micrometastases in breast cancer. / Arch Surg. 2010;145:161-. CrossRef
  16. Heil J, Gondos A, Rauch G, et al. Outcome analysis of patients with primary breast cancer initially treated at a certified academic breast unit. / Breast. 2012;21:303-. CrossRef
  17. Vinh-Hung V, Verkooijen HM, Fioretta G, et al. Lymph node ratio as an alternative to pN staging in node-positive breast cancer. / J Clin Oncol. 2009;27:1062-. CrossRef
  18. Van Belle V, Van Calster B, Wildiers H, et al. Lymph node ratio better predicts disease-free survival in node-positive breast cancer than the number of positive lymph nodes. / J Clin Oncol. 2009;27:e150-; author reply e152.
  19. Whelan T. NCIC-CTG MA.20: an intergroup trial of regional nodal irradiation in early breast cancer. / J Clin Oncol. 2011;abstr LBA1003.
  20. Katz A, Smith BL, Golshan M, et al. Nomogram for the prediction of having four or more involved nodes for sentinel lymph node-positive breast cancer. / J Clin Oncol. 2008;26:2093-. CrossRef
  21. Haffty BG, Hunt KK, Harris JR, Buchholz TA. Positive sentinel nodes without axillary dissection: implications for the radiation oncologist. / J Clin Oncol. 2011;29:4479-1. CrossRef
  22. Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. / Ann Surg. 2010;252:426-2. Discussion 32-3.
  23. Cody HS 3rd. Does the rapid acceptance of ACOSOG Z0011 compromise selection of systemic therapy? / Ann Surg Oncol. 2012;19:3643-. CrossRef
  24. Montemurro F, Maggiorotto F, Valabrega G, et al. Omission of axillary dissection after a positive sentinel node dissection may influence adjuvant chemotherapy indications in operable breast cancer patients. / Ann Surg Oncol. 2012;19:3755-1. CrossRef
  25. Mittendorf EA, Hunt KK, Boughey JC, et al. Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. / Ann Surg. 2012;255:109-5. CrossRef
  26. Van Zee KJ, Manasseh DM, Bevilacqua JL, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. / Ann Surg Oncol. 2003;10:1140-1. CrossRef
  27. Hessman CJ, Naik AM, Kearney NM, et al. Comparative validation of online nomograms for predicting nonsentinel lymph node status in sentinel lymph node-positive breast cancer. / Arch Surg. 2011;146:1035-0. CrossRef
  28. Kamath VJ, Giuliano R, Dauway EL, et al. Characteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the axilla: a study to evaluate the need for complete axillary lymph node dissection. / Arch Surg. 2001;136:688-2. CrossRef
  29. Memorial Sloan-Kettering Cancer Center. Breast Cancer Nomogram: breast additional non-SLN metastases. In: http://nomograms.mskcc.org/Breast/BreastAdditionalNonSLNMetastasesPage.aspx.
  
• 作者单位：Julia Aigner (1) (2)
  Katharina Smetanay (1) (2)
  Holger Hof PhD (3)
  Hans-Peter Sinn (4)
  Christof Sohn (1)
  Andreas Schneeweiss (1) (2)
  Frederik Marmé (1) (2)
  
  1. Department of Obstetrics and Gynecology, University Hospital, Heidelberg, Germany
  2. National Center for Tumour Diseases, University Hospital, Heidelberg, Germany
  3. Department of Radiotherapy, University Hospital, Heidelberg, Germany
  4. Institute of Pathology, University of Heidelberg, Heidelberg, Germany
  

文摘

Objective A recent, randomized trial (ACOSOG Z0011) has demonstrated that omission of completion axillary lymph node dissection (ALND) in patients with one or two sentinel lymph node (SLN) metastases treated with breast conserving therapy (BCT) does not have a negative impact on survival. This study evaluates the impact of omitting ALND on adjuvant treatment recommendations. Methods Performing a search of our clinical database, we identified patients meeting the main inclusion and exclusion criteria of ACOSOG Z0011 treated at the University of Heidelberg Breast Center. We performed blinded mock interdisciplinary tumor boards based on patient and tumor characteristics as well as (1) SLN information or (2) final nodal status after ALND. Differences between treatment recommendations were noted and analyzed. Results A total of 132 patients were included; 80.3?% of these had one and 19.7?% had two metastatic sentinel nodes with a rate of micrometastases only of 19.7?%, and 39.7?% of patients had additional nonsentinel node metastases upon ALND. Overall, there was a change in adjuvant chemotherapy in 18.2?% of cases. Treatment recommendations based on ALND lead to a more aggressive therapy in 16.6?% of cases, all of them with additional metastatic nonsentinel nodes. Chemotherapy was not recommended in only two cases (1.5?%) based on ALND. Based on ALND, irradiation of the supraclavicular and infraclavicular nodes was added in 5.3?% of patients. Conclusions Completion ALND for patients with one or two metastatic sentinel nodes in pT1-2 cN0 PBC treated with BCT does have a relevant impact on adjuvant treatment. This should be considered in shared decision making.