N C Verheuvel1, A C Voogd2, V C G Tjan-Heijnen3, R M H Roumen4. 1. Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. Electronic address: cn.verheuvel@mmc.nl. 2. Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands. 3. Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands. 4. Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands; Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands.
Abstract
BACKGROUND: The ACOSOG Z0011 trial, a randomized controlled trial among patients with sentinel node positive breast cancer treated withbreast conserving therapy, concluded that axillary lymph node dissection (ALND) can be omitted in these patients. However, questions were raised on the general applicability if the results of the Z0011 trial. Therefore, the aim of this study was to assess the practice changing effect of the Z0011 trial by quantifying the proportion of all node positive breast cancer patients who meet the inclusion criteria which are based on the Z0011 trial, thus in whom an ALND could be omitted. METHODS: A multicenter population based study including patients with clinical T1-2N0-1M0 invasive non-metastatic breast cancer, a positive sentinel node or ultrasound guided lymph node biopsy, treated with breast conserving therapy and adjuvant systemic therapy between January 2007 and December 2012. RESULTS: A total of 11,031 patients had invasive breast cancer including 3051 cases treated withbreast conserving therapy and adjuvant systemic therapy. Subsequently, 916 cases with a positive nodal status underwent an ALND of whom 558 cases (60.9%), representing 5.1% of the total breast cancer population, would potentially have fulfilled the Z0011 criteria. CONCLUSION: Application of Z0011 based criteria is practice changing in nearly 61% of all node positive patients, which could result in omission of the ALND in a substantial number of patients in the future. Further research has to be performed on the applicability of these conclusions to other categories of breast cancer patients.
RCT Entities:
BACKGROUND: The ACOSOG Z0011 trial, a randomized controlled trial among patients with sentinel node positive breast cancer treated with breast conserving therapy, concluded that axillary lymph node dissection (ALND) can be omitted in these patients. However, questions were raised on the general applicability if the results of the Z0011 trial. Therefore, the aim of this study was to assess the practice changing effect of the Z0011 trial by quantifying the proportion of all node positive breast cancerpatients who meet the inclusion criteria which are based on the Z0011 trial, thus in whom an ALND could be omitted. METHODS: A multicenter population based study including patients with clinical T1-2N0-1M0 invasive non-metastatic breast cancer, a positive sentinel node or ultrasound guided lymph node biopsy, treated with breast conserving therapy and adjuvant systemic therapy between January 2007 and December 2012. RESULTS: A total of 11,031 patients had invasive breast cancer including 3051 cases treated with breast conserving therapy and adjuvant systemic therapy. Subsequently, 916 cases with a positive nodal status underwent an ALND of whom 558 cases (60.9%), representing 5.1% of the total breast cancer population, would potentially have fulfilled the Z0011 criteria. CONCLUSION: Application of Z0011 based criteria is practice changing in nearly 61% of all node positive patients, which could result in omission of the ALND in a substantial number of patients in the future. Further research has to be performed on the applicability of these conclusions to other categories of breast cancerpatients.
Authors: Carlos Ortega Expósito; Catalina Falo; Sonia Pernas; Samuel Pérez Carton; Miguel Gil Gil; Raul Ortega; Héctor Pérez Montero; Agostina Stradella; Evelyn Martinez; Maria Laplana; Sira Salinas; Ana Luzardo; Teresa Soler; Maria Eulalia Fernández Montoli; Juan Azcarate; Anna Guma; Anna Petit; Ana Benitez; Maite Bajen; Jose G Reyes Junca; Miriam Campos; Raquel Ruiz; Jordi Ponce; Maria J Pla; Amparo García Tejedor Journal: Breast Cancer Res Treat Date: 2021-06-04 Impact factor: 4.872
Authors: Monica Morrow; Kimberly J Van Zee; Sujata Patil; Oriana Petruolo; Anita Mamtani; Andrea V Barrio; Deborah Capko; Mahmoud El-Tamer; Mary L Gemignani; Alexandra S Heerdt; Laurie Kirstein; Melissa Pilewskie; George Plitas; Virgilio S Sacchini; Lisa M Sclafani; Alice Ho; Hiram S Cody Journal: Ann Surg Date: 2017-09 Impact factor: 12.969
Authors: Armando E Giuliano; Karla V Ballman; Linda McCall; Peter D Beitsch; Meghan B Brennan; Pond R Kelemen; David W Ollila; Nora M Hansen; Pat W Whitworth; Peter W Blumencranz; A Marilyn Leitch; Sukamal Saha; Kelly K Hunt; Monica Morrow Journal: JAMA Date: 2017-09-12 Impact factor: 56.272