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

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

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Background and Objective: The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLNs) randomized either to axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. We now report long-term locoregional recurrence results. Methods: ACOSOG Z0011 prospectively examined overall survival of patients with SLN metastases undergoing breast-conserving therapy randomized to undergo ALND after SLND or no further axillary specific treatment. Locoregional recurrence was prospectively evaluated and compared between the groups. Results: Four hundred forty-six patients were randomized to SLND alone and 445 to SLND and ALND. Both groups were similar with respect to age, Bloom-Richardson score, Estrogen Receptor status, adjuvant systemic therapy, histology, and tumor size. Patients randomized to ALND had a median of 17 axillary nodes removed compared with a median of only 2 SLNs removed with SLND alone (P < 0.001). ALND, as expected, also removed more positive lymph nodes (P < 0.001). At a median follow-up of 9.25 years, there was no statistically significant difference in local recurrence-free survival (P = 0.13). The cumulative incidence of nodal recurrences at 10 years was 0.5% in the ALND arm and 1.5% in the SLND alone arm (P = 0.28). Ten-year cumulative locoregional recurrence was 6.2% with ALND and 5.3% with SLND alone (P = 0.36). Conclusion: Despite the potential for residual axillary disease after SLND, SLND without ALND offers excellent regional control for selected patients with early metastatic breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.

Original languageEnglish (US)
Pages (from-to)413-419
Number of pages7
JournalAnnals of Surgery
Volume264
Issue number3
DOIs
StatePublished - Sep 1 2016

Fingerprint

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

Keywords

  • ACOSOG Z0011
  • ALND
  • Locoregional recurrence
  • SLND

ASJC Scopus subject areas

  • Surgery

Cite this

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

In: Annals of Surgery, Vol. 264, No. 3, 01.09.2016, p. 413-419.

Research output: Contribution to journalArticle

Giuliano, Armando E. ; Ballman, Karla ; McCall, Linda ; Beitsch, Peter ; Whitworth, Pat W. ; Blumencranz, Peter ; Leitch, A. Marilyn ; Saha, Sukamal ; Morrow, Monica ; Hunt, Kelly K. / 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. In: Annals of Surgery. 2016 ; Vol. 264, No. 3. pp. 413-419.
@article{100ef682f1bb42859c868c2b4c72c939,
title = "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",
abstract = "Background and Objective: The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLNs) randomized either to axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. We now report long-term locoregional recurrence results. Methods: ACOSOG Z0011 prospectively examined overall survival of patients with SLN metastases undergoing breast-conserving therapy randomized to undergo ALND after SLND or no further axillary specific treatment. Locoregional recurrence was prospectively evaluated and compared between the groups. Results: Four hundred forty-six patients were randomized to SLND alone and 445 to SLND and ALND. Both groups were similar with respect to age, Bloom-Richardson score, Estrogen Receptor status, adjuvant systemic therapy, histology, and tumor size. Patients randomized to ALND had a median of 17 axillary nodes removed compared with a median of only 2 SLNs removed with SLND alone (P < 0.001). ALND, as expected, also removed more positive lymph nodes (P < 0.001). At a median follow-up of 9.25 years, there was no statistically significant difference in local recurrence-free survival (P = 0.13). The cumulative incidence of nodal recurrences at 10 years was 0.5{\%} in the ALND arm and 1.5{\%} in the SLND alone arm (P = 0.28). Ten-year cumulative locoregional recurrence was 6.2{\%} with ALND and 5.3{\%} with SLND alone (P = 0.36). Conclusion: Despite the potential for residual axillary disease after SLND, SLND without ALND offers excellent regional control for selected patients with early metastatic breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.",
keywords = "ACOSOG Z0011, ALND, Locoregional recurrence, SLND",
author = "Giuliano, {Armando E.} and Karla Ballman and Linda McCall and Peter Beitsch and Whitworth, {Pat W.} and Peter Blumencranz and Leitch, {A. Marilyn} and Sukamal Saha and Monica Morrow and Hunt, {Kelly K.}",
year = "2016",
month = "9",
day = "1",
doi = "10.1097/SLA.0000000000001863",
language = "English (US)",
volume = "264",
pages = "413--419",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases

T2 - Long-term follow-up from the American college of surgeons oncology group (Alliance) ACOSOG Z0011 randomized trial

AU - Giuliano, Armando E.

AU - Ballman, Karla

AU - McCall, Linda

AU - Beitsch, Peter

AU - Whitworth, Pat W.

AU - Blumencranz, Peter

AU - Leitch, A. Marilyn

AU - Saha, Sukamal

AU - Morrow, Monica

AU - Hunt, Kelly K.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background and Objective: The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLNs) randomized either to axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. We now report long-term locoregional recurrence results. Methods: ACOSOG Z0011 prospectively examined overall survival of patients with SLN metastases undergoing breast-conserving therapy randomized to undergo ALND after SLND or no further axillary specific treatment. Locoregional recurrence was prospectively evaluated and compared between the groups. Results: Four hundred forty-six patients were randomized to SLND alone and 445 to SLND and ALND. Both groups were similar with respect to age, Bloom-Richardson score, Estrogen Receptor status, adjuvant systemic therapy, histology, and tumor size. Patients randomized to ALND had a median of 17 axillary nodes removed compared with a median of only 2 SLNs removed with SLND alone (P < 0.001). ALND, as expected, also removed more positive lymph nodes (P < 0.001). At a median follow-up of 9.25 years, there was no statistically significant difference in local recurrence-free survival (P = 0.13). The cumulative incidence of nodal recurrences at 10 years was 0.5% in the ALND arm and 1.5% in the SLND alone arm (P = 0.28). Ten-year cumulative locoregional recurrence was 6.2% with ALND and 5.3% with SLND alone (P = 0.36). Conclusion: Despite the potential for residual axillary disease after SLND, SLND without ALND offers excellent regional control for selected patients with early metastatic breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.

AB - Background and Objective: The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLNs) randomized either to axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. We now report long-term locoregional recurrence results. Methods: ACOSOG Z0011 prospectively examined overall survival of patients with SLN metastases undergoing breast-conserving therapy randomized to undergo ALND after SLND or no further axillary specific treatment. Locoregional recurrence was prospectively evaluated and compared between the groups. Results: Four hundred forty-six patients were randomized to SLND alone and 445 to SLND and ALND. Both groups were similar with respect to age, Bloom-Richardson score, Estrogen Receptor status, adjuvant systemic therapy, histology, and tumor size. Patients randomized to ALND had a median of 17 axillary nodes removed compared with a median of only 2 SLNs removed with SLND alone (P < 0.001). ALND, as expected, also removed more positive lymph nodes (P < 0.001). At a median follow-up of 9.25 years, there was no statistically significant difference in local recurrence-free survival (P = 0.13). The cumulative incidence of nodal recurrences at 10 years was 0.5% in the ALND arm and 1.5% in the SLND alone arm (P = 0.28). Ten-year cumulative locoregional recurrence was 6.2% with ALND and 5.3% with SLND alone (P = 0.36). Conclusion: Despite the potential for residual axillary disease after SLND, SLND without ALND offers excellent regional control for selected patients with early metastatic breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.

KW - ACOSOG Z0011

KW - ALND

KW - Locoregional recurrence

KW - SLND

UR - http://www.scopus.com/inward/record.url?scp=84983086722&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84983086722&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000001863

DO - 10.1097/SLA.0000000000001863

M3 - Article

C2 - 27513155

AN - SCOPUS:84983086722

VL - 264

SP - 413

EP - 419

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -