Should ACOSOG Z0011 change practice with respect to axillary lymph node dissection for a positive sentinel lymph node biopsy in breast cancer? Journal Article

Authors: Giuliano, A. E.; Morrow, M.; Duggal, S.; Julian, T. B.
Article Title: Should ACOSOG Z0011 change practice with respect to axillary lymph node dissection for a positive sentinel lymph node biopsy in breast cancer?
Abstract: While any study can be criticized, the results of Z0011 clearly show that sentinel lymph node biopsy (SLNB) alone without axillary lymph node dissection (ALND) results in extremely low locoregional recurrence and excellent overall survival comparable to completion ALND. The observed results in this trial with SLNB alone were excellent. A prospective randomized study with results such as Z0011 should alter therapy. The skilled clinician must utilize his or her experience and the prospective randomized data of this study to improve patient care for women with breast cancer. On the other hand, ALND continues to be the standard of care for positive nodes in the axilla, with lymph node status as the most important prognostic indicator in overall survival (OS) and disease-free survival (DFS) in the management of early stage breast cancer. The advent of sentinel lymph node resection (SLNR) is challenging this notion. There is evidence to support the need for regional control of the axilla as a preventative means for locoregional recurrence and improvement in DFS. ALND is both a diagnostic and therapeutic approach that not only decreases rates of locoregional recurrence, but also guides further treatment strategies. Currently, there are no definable criteria that completely prevent patients from benefiting from ALND in the setting of metastatic disease to the axilla. It is, therefore, clear that ALND should be strongly considered in the management of the SLN-positive axilla. SLNR has its role in the management of early stage breast cancer, but whether SLNR alone should replace ALND is yet to be determined. © Springer Science+Business Media B.V. 2012.
Keywords: controlled study; disease-free survival; cancer surgery; overall survival; cancer recurrence; conference paper; disease free survival; outcome assessment; lymph node dissection; lymph nodes; lymphatic metastasis; prospective study; sentinel lymph node; lymph node excision; sentinel lymph node biopsy; clinical practice; neoplasm recurrence, local; breast cancer; randomized controlled trial; breast neoplasms; biopsy; patient care; cancer control; axilla; axillary lymph node extirpation; axillary dissection; cancer prognosis
Journal Title: Clinical and Experimental Metastasis
Volume: 29
Issue: 7
ISSN: 0262-0898
Publisher: Springer  
Date Published: 2012-10-01
Start Page: 687
End Page: 692
Language: English
DOI: 10.1007/s10585-012-9515-z
PROVIDER: scopus
PUBMED: 22926446
Notes: --- - "Export Date: 3 December 2012" - "CODEN: CEXMD" - "Source: Scopus"
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MSK Authors
  1. Monica Morrow
    629 Morrow