Management of Early Node-Positive Breast Cancer in Australia: A Multicentre Study

Abstract

To examine practice patterns for breast cancer patients with limited sentinel node (SN) disease in light of the ACOSOG Z0011 results. Retrospective analysis of patients with T1-2 breast cancer and positive sentinel lymph node biopsy (SLNB) admitted between January 2009 and December 2012. Patient demographics, tumor characteristics, and treatments were recorded. Eight hundred positive SLNBs were identified. A total of 452 (56.5%) proceeded to completion axillary lymph node dissection (cALND). cALND rate decreased from 65.1% to 49.7% from 2009-2010 to 2011-2012. cALND was performed for micrometastasis or isolated tumor cells in 39.3% in 2009-2010 and 22.2% in 2011-2012, whereas for macrometastases the rates were 83.1% and 68.6%, respectively. cALND rates diminished for both Z0011-eligible and -ineligible patients. The ACOSOG Z0011 trial presentation and publication coincided with a reduction in cALND for breast cancer with limited nodal disease. There appears equipoise regarding management of macrometastatic SN disease.

Does the presence of sentinel lymph node macrometastases in breast cancer patients require axillary lymph node dissection?-Single-center analysis

“…In studies initiated by Giuliano et al, it has been established that regardless of SLN lesions, it is possible to refrain from ALND in selected breast cancer patients. These studies were followed by analyses reported by other authors, including one study conducted at our department . The collecting of further clinical evidence validating such a decision can substantiate the general application of conservative treatment (similarly to SLN(+) patients with micrometastases).…”

“…In the years 2009 and 2010 (pre‐Z0011 era), 16.9% of our patients qualified for observation. However, in the years 2011 and 2012 (post‐Z0011 era), the percentage reached 31.2% …”

“…One of the main goals of studies analyzing treatment results is to evaluate the possible use of conservative treatment, for example, no completion ALND in SLN(+) patients. It predominantly refers to patients with macrometastases in sentinel lymph node …”

“…It predominantly refers to patients with macrometastases in sentinel lymph node. [6][7][8][9][10][11][12][13][14] T A B L E 3 Clinical characteristics of patients with sentinel lymph node metastases diagnosed as macrometastases and qualified for ALND and conservative treatment-no ALND…”

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

“…This is in part due to the initial reservations by many Australian surgeons and oncologists regarding the Z0011 study methodology such as the trial closing early with less than 50% target accrual, high survival and low event rate, significant number of women lost to follow‐up, and the radiation techniques not clearly described such as dosing, frequency and field definitions. The ongoing UK‐ANZ POSNOC trial will include 1900 women with around 250 women from Australia and New Zealand. This multicenter non‐inferiority prospective randomized trial aims to assess whether adjuvant therapy alone is no worse than adjuvant therapy plus axillary treatment for early breast cancer with one or two sentinel nodes containing macrometastases.…”