Effect of the American College of Surgeons Oncology Group Z0011 trial on axillary management in breast cancer patients in the Australian setting

Ngui, Nicholas K.; Hitos, Kerry; Hughes, Michael

doi:10.1111/tbj.13343

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…Similarly, the MD Anderson group (13) has shown a marked decrease in ALND from 85% to 25% after Z0011 and this trend has become more pronounced over time. Similar trend of ALND reduction of up to 34% have likewise been observed in Europe (14,15) and Australia (16). This abrupt transition away from ALND is in no doubt associated with less surgical morbidities (4,17).…”

Section: Discussionsupporting

confidence: 74%

The applicability of the ACOSOG Z0011 Criteria to breast cancer patients in Hong Kong

Man¹,

Lo²,

Kwong³

2021

Chin Clin Oncol

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Background:The ACOSOG Z0011 trial demonstrated safe omission of axillary lymph node dissection (ALND) in patients with one or two positive sentinel lymph nodes (SLNs) receiving breast conservative surgery, followed by whole breast irradiation and adjuvant systemic treatment. This study aims to evaluate the exportability of the ACOSOG Z0011 criteria in an Asian/Chinese cohort residing in Hong Kong.Methods: Retrospective analysis of a prospectively maintained database in a University affiliated tertiary breast centre was performed from June 2014 to May 2019. All breast cancer patients with no palpable adenopathy before surgery, one or more positive sentinel lymph nodes on histological examination and no prior neoadjuvant systemic treatment were recruited. Patients were grouped as eligible or ineligible according to the ACOSOG Z0011 criteria. The eligible group was compared with the sentinel alone group in the ACOSOG Z0011 cohort.Results: Two hundred and forty-eight patients were recruited into the study. Sixty patients (24%) met the ACOSOG Z0011 criteria and could potentially avoid ALND. A higher percentage of clinical T2 tumors were observed in our eligible group than in the ACOSOG Z0011 trial (P=0.002). The histological subtype, tumor grade, estrogen receptor (ER)/progestogen receptor (PR) status and lymphovascular invasion status did not differ. There was no statistically significant difference in the proportion of SLN micrometastasis and macrometastasis between the two groups.Conclusions: This study demonstrated clinical similarities between our eligible cohort and the ACOSOG Z0011 cohort, which confirms exportability of the ACOSOG Z0011 criteria to a subset of population in

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Section: Discussionsupporting

confidence: 74%

The applicability of the ACOSOG Z0011 Criteria to breast cancer patients in Hong Kong

Man¹,

Lo²,

Kwong³

2021

Chin Clin Oncol

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“…Several validation studies have supported the results of the Z0011 trial, mainly in Western populations with a high proportion of screen-detected breast cancer [ 12 , 14 , 15 ]. In the United Kingdom, the ongoing RCT POSNOC (Positive Sentinel Node – Adjuvant therapy alone versus Adjuvant therapy plus Clearance or Axillary Radiotherapy) is recruiting patients undergoing either BCS or mastectomy with up to two SLN macrometastases, who are randomised to either no further axillary treatment or additional treatment (ALND or axillary radiotherapy) [ 16 ].…”

Section: Introductionmentioning

confidence: 93%

Effect of non-sentinel metastasis on adjuvant treatment decisions and survival in Z0011 eligible non-screened detected breast cancer population

Agrawal¹,

Kewlani²,

Priya³

et al. 2021

ecancer

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Background The Z0011 trial results have shown that axillary lymph node dissection (ALND) can be avoided in cT1-2 patients undergoing breast conservation surgery with 1–2 metastatic sentinel lymph nodes (SLNs). We compared the clinicopathological characteristics of the Z0011 eligible non-screen detected breast cancer patients’ cohort with the Z0011 trial study population. Additionally, we have explored the effect of non-sentinel metastasis on adjuvant treatment decisions and survival. Methods The details of early breast cancer (EBC) patients fulfilling Z0011 eligibility criteria were retrieved from a prospectively maintained database (2013–2017) and electronic medical records. We used Statistical Package for the Social Sciences 25 and Stata V15 for the data analysis. Results 128/194 (66%) sentinel lymph node biopsy positive patients had fulfilled the Z0011 inclusion criteria. Compared to the Z0011 study, our cohort patients were younger, with more aggressive disease (higher T2, Grade 3), had a higher rate of macrometastasis (82.8% versus 58.8%) and non-SLN metastasis (48% versus 27%). The information gained by ALND had changed decisions for chemotherapy in 3% and no change of radiotherapy in Z0011 eligible patients. Further nodal positivity in completion ALND was not significantly associated with overall survival ( p = 0.86) and disease-free survival ( p = 0.5). Conclusion Z0011 eligible Indian EBC patients are significantly different from the Z0011 study population, with younger age of presentation, higher grade, a higher rate of both SLN macro metastasis and non-SLN positivity. The impact of non-sentinel metastasis on adjuvant treatment decisions and survival is minimal.

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“…In the study by MD Anderson [5], it is also noted that there is a significantly low incidence of positive SLN after NAC in T2 and T3, and there was a decreased trend in T1.Therefore, there is a likely recommendation that doing SLN after NAC can reduce ALND rate. But after the ACOZOG Z0011 [9] launch, the rate of ALND in pre chemotherapy decreased [10,11] due to the acceptance of 1-2 nodal positive breast conserving surgery in T1-T2 patients who will receive whole breast radiation. Whereas for NAC patients, even in the case of only one SLN positive there should be a progression to ALND.…”

Section: When Should Sln Be Done: Before Nac Vs Post Nac To Reduce Th...mentioning

confidence: 99%

Axillary Management after Neoadjuvant Chemotherapy; A Review of How and When?

2022

J Surg

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Axillary management in breast cancer has multiple paradigm changes. From standard axillary dissection level 1 and level 2 to sentinel lymph node biopsy in early-stage breast cancer. Now sentinel lymph node biopsy trend to use after neoadjuvant treatment to reduce the morbidity from standard axillary dissection. This review is collecting information on axillary management after neoadjuvant chemotherapy. Such as how to improve the accuracy of SLN in initial clinical nodal negative and initial clinical nodal positive before receiving neoadjuvant treatment, the role of axillary dissection after SLN, and the role of radiation therapy and the factors that predict the pathological nodal negative after neoadjuvant treatment. This review can support surgeons who decide to do SLN after neoadjuvant treatment.

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Effect of the American College of Surgeons Oncology Group Z0011 trial on axillary management in breast cancer patients in the Australian setting

Cited by 7 publications

References 22 publications

The applicability of the ACOSOG Z0011 Criteria to breast cancer patients in Hong Kong

The applicability of the ACOSOG Z0011 Criteria to breast cancer patients in Hong Kong

Effect of non-sentinel metastasis on adjuvant treatment decisions and survival in Z0011 eligible non-screened detected breast cancer population

Axillary Management after Neoadjuvant Chemotherapy; A Review of How and When?

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