Management of the axilla: has Z0011 had an impact?

Joyce, Doireann; Lowery, Aoife; McGrath-Soo, L. B.; Downey, E; Kelly, Louise; O’Donoghue, G.T.; Barry, Mitchel; Hill, Arnold D.

doi:10.1007/s11845-015-1246-0

Cited by 29 publications

(21 citation statements)

References 26 publications

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“…15 Other single institutional investigations have confirmed similar findings with a significant change in clinical practice since the Z0011 study. [16][17][18][19][20] This is the first Australian of the Z0011 results in Australia has been slow following the publication of the Z0011 study. Unlike many other countries, there is yet to be an Australian national cancer guideline from Cancer Australia adopting the results of the Z0011 study.…”

Section: Discussionmentioning

confidence: 99%

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

2019

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The American College of Surgeons Oncology Group Z0011 Trial demonstrated that early breast cancer patients with positive axillary sentinel lymph nodes treated with breast‐conserving surgery and breast radiotherapy had no additional oncologic benefit of proceeding to an axillary lymph node dissection (ALND). The extent to which practice has changed in Australia remains unclear. The aim of this study was to investigate the effect of the Z0011 trial on the management of positive axillary sentinel nodes at an Australian institutional level. We reviewed all breast cancer cases treated at the Sydney Adventist Hospital over a 10‐year period from 1 January 2008 to 31 December 2017. Patients who fulfilled the Z0011 trial criteria were selected. These patients were divided into two groups according to the year of surgery, before and after 1 January 2011 when the Z0011 study was published. Clinicopathologic data and axillary surgical management were compared. Of the 237 patients fulfilling the Z0011 trial criteria, there were 73 patients before and 158 patients after 1 January 2011. In the earlier group the rate of proceeding to an ALND following a positive sentinel node was 78.1% compared to 43.7% in the latter group (P < 0.0001). There was a significant decline in the rate of ALND over this 10‐year period (r = −0.79, P = 0.006). The Z0011 trial has influenced the surgical management of the axilla leading to a significant reduction in the rate of an ALND in patients fulfilling the Z0011 trial criteria at our institution.

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Section: Discussionmentioning

confidence: 99%

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

2019

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“…In a randomized trial conducted in 2010, the decision to perform ALND after SLNB during BCS was made based on the size of the tumor and the number of metastatic lymph nodes [ 8 ]. Since then, several studies have been published in which ALND was not performed in patients with early breast cancer who had one to two positive lymph nodes on SLNB, with no adverse effects on DSS rates; the subsequent use of ALND tended to decrease over time [ 14 15 16 17 18 19 ]. In an analysis of Surveillance, Epidemiology, and End Results Program data, no differences were found in DSS or OS in patients with breast cancer (n=9,521) who did or did not receive ALND, including those with T1–T2 disease and ≥3 positive lymph nodes upon SLNB [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Comparative Study between Sentinel Lymph Node Biopsy and Axillary Dissection in Patients with One or Two Lymph Node Metastases

et al. 2018

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PurposeSentinel lymph node biopsy (SLNB) is a standard axillary surgery in early breast cancer. If the SLNB result is positive, subsequent axillary lymph node dissection (ALND) is a routine procedure. In 2011, the American College of Surgeons Oncology Group Z0011 trial revealed that ALND may not be necessary in early breast cancer with one or two positive sentinel lymph nodes. The purpose of this study was to compare outcomes among Korean patients with one or two positive axillary lymph nodes in the final pathology who did and did not undergo ALND.MethodsA total of 131,717 patients from the Korea Breast Cancer Society registry database received breast cancer surgery from January 1995 to December 2014. Inclusion criteria were T stage 1 or 2, one or two positive lymph nodes, and having received breast-conserving surgery (BCS), whole breast radiation therapy, and no neoadjuvant therapy. We analyzed the differences in disease-specific survival (DSS) and overall survival (OS) between patients who received SLNB only and those who underwent SLNB+ALND.ResultsA total 4,442 patients met the inclusion criteria, with 1,268 (28.6%) in the SLNB group and 3,174 (71.4%) in the SLNB+ALND group. There were no differences in DSS and OS between the two groups (p=0.378 and p=0.925, respectively). The number of patients who underwent SLNB alone for one or two positive lymph nodes increased continuously from 2004 to 2014.ConclusionKorean patients with early breast cancer and 1 or 2 positive axillary lymph nodes who received BCS plus SLNB showed no significant difference in DSS and OS regardless of whether they received ALND. The findings of this retrospective study demonstrate that omitting ALND can be considered when treating selected patients with early breast cancer who have one or two positive lymph nodes.

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“…These studies have had an impact on practice patterns with regard to the axilla [21] however, caution must be exercised before trial data can be extrapolated to all patients with invasive breast cancer. It is important to remain cogniscent of the fact that these trials adhered to well defined eligibility criteria, for example, ACOSOG Z0011 found indistinguishable disease-free and overall survival in patients with small tumours (T2 or less) and 1-2 positive sentinel lymph nodes [11].…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis to determine the clinical impact of axillary lymph node dissection in the treatment of invasive breast cancer

Joyce

Manning

Carter

et al. 2015

Breast Cancer Res Treat

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There are divergent opinions regarding the optimum surgical management of the axilla in patients with invasive breast cancer. Guidelines mandate axillary lymph node dissection (ALND) in the setting of positive sentinel lymph nodes. However, recent studies have questioned the true benefits of this procedure. Therefore, a meta-analysis of relevant randomized trials was performed in order to clarify the oncological benefit of axillary lymph node dissection. A comprehensive search of published randomized trials that compared patients with primary operable breast cancer with/without ALND was performed using MEDLINE, and available data were cross-referenced. Reviews of each study were conducted, and data were extracted. Primary outcomes were overall survival and recurrent axillary disease. A total of 7347 patients with operable primary breast cancer were identified from 8 randomised controlled trials comparing axillary recurrence in patients with or without ALND. Six of these trials provided data on overall survival on 6895 patients. Overall survival favours patients having ALND (OR = 1.22 (95% CI 1.03-1.44, p = 0.02). Similarly, patients undergoing ALND had increased recurrence-free survival (OR = 2.25 (95% CI 1.28-3.94, p = 0.0047). ALND appears to positively impact on overall and recurrence-free survival from breast cancer. These data highlight the enduring benefits of ALND in an era where adjuvant therapies are being promoted to manage regionally advanced/metastatic disease.

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Management of the axilla: has Z0011 had an impact?

Abstract: There has been a change in clinical practice since the publication of the Z0011 trial, illustrated by a decrease in the rate of axillary clearance in node-positive breast cancers.

Cited by 29 publications

References 26 publications

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

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

Comparative Study between Sentinel Lymph Node Biopsy and Axillary Dissection in Patients with One or Two Lymph Node Metastases

Meta-analysis to determine the clinical impact of axillary lymph node dissection in the treatment of invasive breast cancer

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