👉The results of the ACOSOG Z0011 clearly demonstrate that patients with one to two positive sentinel lymph nodes who undergo a breast-conserving operation followed by whole breast radiation can safely forego completion ALND.
👉Patients treated with mastectomy were not included in this trial, and applicability of the Z0011 results to these patients has not been established.
👉A retrospective review examined the outcomes in a series of patients with a positive SLNB undergoing mastectomy who received no further axillary treatment.
👉The patients treated with total mastectomy were on average younger and had larger tumors than the patients who underwent breast-conserving operations.
👉Ninety-four percent of the breast conservation group and 5% of the total mastectomy group underwent postmastectomy radiation.
👉At 4 years, three patients in the mastectomy group (1%) and three patients in the breast conservation group (1%) had an axillary recurrence.
👉The authors concluded that early-stage breast cancer patients with minimal nodal disease who undergo mastectomy experience excellent outcomes without ALND.
👉Another recent report followed 58 highly selected node-positive mastectomy patients who did not undergo ALND or nodal radiation.
👉At a median follow-up of 5.5 years, two of the 58 patients (3.4%) developed regional recurrence, with only one axillary recurrence.
👉The conclusions of both studies are limited by the small numbers of patients with macrometastatic lymph node disease.
👉A study in the Netherlands (BOOG 2013-07) seeks to determine whether completion axillary treatment can be safely omitted in sentinel lymph node–positive breast cancer patients treated with mastectomy.
👉T1-T2, clinically node-negative patients are randomized following mastectomy to no further axillary-specific treatment, radiation, or completion ALND.
👉The results should help clarify the role of ALND in these patients.
👉ASCO guidelines currently do not recommend SLNB alone for mastectomy patients with a positive SLNB.
👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:
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Es experto en el manejo del cáncer de mama.
Training:
• General surgery:
• Michigan State University:
• 2004 al 2010
• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:
• Fox Chase Cancer Center (Filadelfia):
• 2010 al 2012
• Masters in Science (Clinical research for health professionals):
• Drexel University (Filadelfia):
• 2010 al 2012
• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:
• IFHNOS / Memorial Sloan Kettering Cancer Center:
• 2014 al 2016
Rodrigo Arrangoiz MS, MD, FACS, FSSO 