Axillary dissection and nodal irradiation can be avoided for most node-positive Z0011-eligible breast cancers: A prospective validation study of 793 patients Journal Article


Authors: Morrow, M.; Van Zee, K. J.; Patil, S.; Petruolo, O.; Mamtani, A.; Barrio, A. V.; Capko, D.; El-Tamer, M.; Gemignani, M. L.; Heerdt, A. S.; Kirstein, L.; Pilewskie, M.; Plitas, G.; Sacchini, V. S.; Sclafani, L. M.; Ho, A.; Cody, H. S.
Article Title: Axillary dissection and nodal irradiation can be avoided for most node-positive Z0011-eligible breast cancers: A prospective validation study of 793 patients
Abstract: Objective: To determine rates of axillary dissection (ALND) and nodal recurrence in patients eligible for ACOSOG Z0011. Background: Z0011 demonstrated that patients with cT1-2N0 breast cancers and 1 to 2 involved sentinel lymph nodes (SLNs) having breast-conserving therapy had no difference in locoregional recurrence or survival after SLN biopsy alone or ALND. The generalizability of the results and importance of nodal radiotherapy (RT) is unclear. Methods: Patients eligible for Z0011 had SLN biopsy alone. Prospectively defined indications for ALND were metastases in ≥3 SLNs or gross extracapsular extension. Axillary imaging was not routine. SLN and ALND groups and radiation fields were compared with chi-square and t tests. Cumulative incidence of recurrences was estimated with competing risk analysis. Results: From August 2010 to December 2016, 793 patients met Z0011 eligibility criteria and had SLN metastases. Among them, 130 (16%) had ALND; ALND did not vary based on age, estrogen receptor, progesterone receptor, or HER2 status. Five-year event-free survival after SLN alone was 93% with no isolated axillary recurrences. Cumulative 5-year rates of breast + nodal and nodal + distant recurrence were each 0.7%. In 484 SLN-only patients with known RT fields (103 prone, 280 supine tangent, 101 breast + nodes) and follow-up ≥12 months, the 5-year cumulative nodal recurrence rate was 1% and did not differ significantly by RT fields. Conclusions: We confirm that even without preoperative axillary imaging or routine use of nodal RT, ALND can be avoided in a large majority of Z0011-eligible patients with excellent regional control. This approach has the potential to spare substantial numbers of women the morbidity of ALND. © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: breast cancer; axillary lymph node dissection; nodal recurrence
Journal Title: Annals of Surgery
Volume: 266
Issue: 3
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2017-09-01
Start Page: 457
End Page: 461; discussion 461-462
Language: English
DOI: 10.1097/sla.0000000000002354
PROVIDER: scopus
PUBMED: 28650355
PMCID: PMC5649371
DOI/URL:
Notes: Article -- Export Date: 1 September 2017 -- Source: Scopus
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MSK Authors
  1. Sujata Patil
    386 Patil
  2. Andrea Veronica Barrio
    38 Barrio
  3. Monica Morrow
    455 Morrow
  4. Deborah Capko
    10 Capko
  5. Kimberly J Van Zee
    243 Van Zee
  6. Hiram S Cody III
    210 Cody
  7. Mary L Gemignani
    146 Gemignani
  8. Alexandra S Heerdt
    86 Heerdt
  9. George Plitas
    53 Plitas
  10. Anita   Mamtani
    19 Mamtani