Life beyond Z11.

The ACOSOG Z0011 (Z11) trial demonstrated the presence of a group of breast cancer patients with some residual axillary disease who did not benefit from axillary lymph node dissection (ALND) in the presence of whole breast radiotherapy and systemic therapy at short term follow-up. It is important that further long-term follow-up of this cohort continues. The outcomes of those patients fitting Z11 criteria who do not undergo ALND should be recorded on a prospective register to ensure close observation should any late divergence in overall survival develop. It is also essential that future studies are inclusive of groups excluded from Z11 rather than simply a re-hash of the trial.