ACOSOG Z0011 Trial

  • In the ACOSOG Z0011 trial:
    • The impact of axillary dissection on the outcomes of both pre- and postmenopausal patients:
      • With clinically T1 to T2, N0 breast cancers was studied
    • Clinically node-negative breast cancer patients:
      • Treated with breast-conserving surgery with 1 to 2 positive SLNs:
        • Were randomized to:
          • Axillary lymph node dissection (ALND) or no additional axillary surgery
    • All women were recommended:
      • For whole-breast irradiation
    • Systemic therapy:
      • Was left to the discretion of the treating physician:
        • But 96% of women in the ALND arm and 97% in the SLN arm:
          • Received some type of systemic therapy
    • Patients were randomized:
      • To receive completion ALND, or
      • No immediate additional axillary surgery
    • Patients were monitored fo:
      • Local and regional recurrence, distant recurrence, contralateral breast cancers, and death
    • The study showed that in patients with T1 to T2 breast cancers with 1 to 2 positive SLNs:
      • There were no significant differences in:
        • DFS and OS between patients treated with:
          • SLND (DFS: 83.9%, OS: 92.5%) or
          • ALND (DFS: 82.2%, OS: 91.8%)
      • As anticipated, surgical morbidity was significantly decreased in the SLN-only group, with:
        • Fewer wound infections (P=0.016), paresthesias (P<0.001), and subjective lymphedema (P<0.001)
      • Although approximately:
        • 37% of ALND patients and 45% of SLN only patients had micrometastatic disease only in the sentinel node:
          • The remaining had macrometastasic nodal disease demonstrating that the Z0011 criteria can be applied to both groups of patients
  • Finally, Chung et al.:
    • Applied the ACOSOG Z0011 criteria to:
      • High-risk, node-positive breast cancer patients undergoing breast conservation including patients:
        • Younger than age 50 years who were considered by some to be ineligible for management using Z0011 criteria due to poor prognosis
    • Overall, 186 high-risk breast cancer patients with at least 1 positive node were identified:
      • 57 (31%) were HER2-positive
      • 55 (30%) were triple negative
      • 74 (40%) were younger than age 50 years.
    • Of the eligible patients who had an ALND (n = 105):
      • 38% had involvement of non-sentinel nodes
      • The median number of positive non-sentinel nodes was only 1 (range 1–3)
    • These findings demonstrate that patients with high-risk tumor features:
      • Are not more likely to have a higher burden of residual axillary nodal disease compared to low-risk patients:
        • Confirming that Z0011 criteria can be applied to a heterogeneous breast cancer population with similar results

#Arrangoiz #Surgeon #BreastSurgeon #CancerSurgeon #SurgicalOncologist #BreastCancer

REFERENCES

  1. Chung A, Gangi A, Mirocha J, Giuliano A. Applicability of the ACOSOG Z0011 criteria in women with high-risk node-positive breast cancer undergoing breast conserving surgery. Ann Surg Oncol. 2015;22:1128-1132.
  2. Giuliano AE, Ballman K, McCall L. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg. 2016;264:413-420.
  3. 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;252:426-432.
  4. Latosinsky S, Berrang TS, Cutter CS, et al; for the Members of the Evidence Based Reviews in Surgery Group. CAGS and ACS evidence based reviews in surgery. 40. Axillary dissection versus no axillary dissection in women with invasive breast cancer and sentinel node metastasis. Can J Surg. 2012;55:66-69.
  5. Lucci A, McCall LM, Beitsch PD, et al; American College of Surgeons Oncology Group. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007;25:3657-3663.

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