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

Armando E. Giuliano, Linda McCall, Peter Beitsch, Pat W. Whitworth, Peter Blumencranz, A. Marilyn Leitch, Sukamal Saha, Kelly K. Hunt, Monica Morrow, Karla Ballman

Research output: Contribution to journalArticle

805 Citations (Scopus)

Abstract

Background and Objective: Sentinel lymph node dissection (SLND) has eliminated the need for axillary dissection (ALND) in patients whose sentinel node (SN) is tumor-free. However, completion ALND for patients with tumor-involved SNs remains the standard to achieve locoregional control. Few studies have examined the outcome of patients who do not undergo ALND for positive SNs. We now report local and regional recurrence information from the American College of Surgeons Oncology Group Z0011 trial. Methods: American College of Surgeons Oncology Group Z0011 was a prospective trial examining survival of patients with SN metastases detected by standard H and E, who were randomized to undergo ALND after SLND versus SLND alone without specific axillary treatment. Locoregional recurrence was evaluated. Results: There were 446 patients randomized to SLND alone and 445 to SLND + ALND. Patients in the 2 groups were similar with respect to age, Bloom-Richardson score, estrogen receptor status, use of adjuvant systemic therapy, tumor type, T stage, and tumor size. Patients randomized to SLND + ALND had a median of 17 axillary nodes removed compared with a median of only 2 SN removed with SLND alone (P < 0.001). ALND also removed more positive lymph nodes (P < 0.001). At a median follow-up time of 6.3 years, there were no statistically significant differences in local recurrence (P = 0.11) or regional recurrence (P = 0.45) between the 2 groups. Conclusions: Despite the potential for residual axillary disease after SLND, SLND without ALND can offer excellent regional control and may be reasonable management for selected patients with early-stage breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.

Original languageEnglish (US)
Pages (from-to)426-432
Number of pages7
JournalAnnals of Surgery
Volume252
Issue number3
DOIs
StatePublished - 2010

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Lymph Node Excision
Dissection
Neoplasm Metastasis
Recurrence
Neoplasms
Sentinel Lymph Node
Surgeons
Therapeutics
Estrogen Receptors
Breast
Lymph Nodes
Breast Neoplasms
Survival

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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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. / Giuliano, Armando E.; McCall, Linda; Beitsch, Peter; Whitworth, Pat W.; Blumencranz, Peter; Leitch, A. Marilyn; Saha, Sukamal; Hunt, Kelly K.; Morrow, Monica; Ballman, Karla.

In: Annals of Surgery, Vol. 252, No. 3, 2010, p. 426-432.

Research output: Contribution to journalArticle

Giuliano, Armando E. ; McCall, Linda ; Beitsch, Peter ; Whitworth, Pat W. ; Blumencranz, Peter ; Leitch, A. Marilyn ; Saha, Sukamal ; Hunt, Kelly K. ; Morrow, Monica ; Ballman, Karla. / 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. In: Annals of Surgery. 2010 ; Vol. 252, No. 3. pp. 426-432.
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T1 - Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases

T2 - The American college of surgeons oncology group z0011 randomized trial

AU - Giuliano, Armando E.

AU - McCall, Linda

AU - Beitsch, Peter

AU - Whitworth, Pat W.

AU - Blumencranz, Peter

AU - Leitch, A. Marilyn

AU - Saha, Sukamal

AU - Hunt, Kelly K.

AU - Morrow, Monica

AU - Ballman, Karla

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AB - Background and Objective: Sentinel lymph node dissection (SLND) has eliminated the need for axillary dissection (ALND) in patients whose sentinel node (SN) is tumor-free. However, completion ALND for patients with tumor-involved SNs remains the standard to achieve locoregional control. Few studies have examined the outcome of patients who do not undergo ALND for positive SNs. We now report local and regional recurrence information from the American College of Surgeons Oncology Group Z0011 trial. Methods: American College of Surgeons Oncology Group Z0011 was a prospective trial examining survival of patients with SN metastases detected by standard H and E, who were randomized to undergo ALND after SLND versus SLND alone without specific axillary treatment. Locoregional recurrence was evaluated. Results: There were 446 patients randomized to SLND alone and 445 to SLND + ALND. Patients in the 2 groups were similar with respect to age, Bloom-Richardson score, estrogen receptor status, use of adjuvant systemic therapy, tumor type, T stage, and tumor size. Patients randomized to SLND + ALND had a median of 17 axillary nodes removed compared with a median of only 2 SN removed with SLND alone (P < 0.001). ALND also removed more positive lymph nodes (P < 0.001). At a median follow-up time of 6.3 years, there were no statistically significant differences in local recurrence (P = 0.11) or regional recurrence (P = 0.45) between the 2 groups. Conclusions: Despite the potential for residual axillary disease after SLND, SLND without ALND can offer excellent regional control and may be reasonable management for selected patients with early-stage breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.

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