Trends on Axillary Surgery in Nondistant Metastatic Breast Cancer Patients Treated Between 2011 and 2015

Poodt, Ingrid G. M.; Spronk, P.E.R.; Vugts, Guusje; Dalen, Thijs van; Peeters, Marie‐Jeanne T. F. D. Vrancken; Rots, Marjolijn L.; Kuijer, Anne; Nieuwenhuijzen, Grard A. P.; Schipper, Robert-Jan

doi:10.1097/sla.0000000000002440

Cited by 62 publications

(52 citation statements)

References 27 publications

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“…A Dutch population based study showed that between 2011 and 2015, the use of ALND following a positive SLNB significantly decreased from 24% to 6%. 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.…”

Section: Discussionsupporting

confidence: 53%

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: Discussionsupporting

confidence: 53%

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 number of patients aged 70 years or above seems lower in the present study than in previous studies. This might be explained by the fact that adjuvant chemotherapy is used less frequently in these older women in the Netherlands. Furthermore, postmastectomy IBR is used less frequently in this patient group in the Netherlands.…”

Section: Discussionmentioning

confidence: 99%

Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy

Heeg

Harmeling

Becherer

et al. 2019

British Journal of Surgery

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Background: Initiation of adjuvant chemotherapy within 6-12 weeks after mastectomy is recommended by guidelines. The aim of this population-based study was to investigate whether immediate breast reconstruction (IBR) after mastectomy reduces the likelihood of timely initiation of adjuvant chemotherapy.Methods: All patients with breast cancer who had undergone mastectomy and adjuvant chemotherapy between 2012 and 2016 in the Netherlands were identified. Time from surgery to adjuvant chemotherapy was categorized as within 6 weeks or after more than 6 weeks, within 9 weeks or after more than 9 weeks, and within 12 weeks or after more than 12 weeks. The impact of IBR on the initiation of adjuvant chemotherapy for these three scenarios was estimated using propensity score matching to adjust for treatment by indication bias.Results: A total of 6300 patients had undergone primary mastectomy and adjuvant chemotherapy, of whom 1700 (27⋅0 per cent) had received IBR. Multivariable analysis revealed that IBR reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (odds ratio (OR) 0⋅76, 95 per cent c.i. 0⋅66 to 0⋅87) and 9 weeks (0⋅69, 0⋅54 to 0⋅87), but not within 12 weeks (OR 0⋅75, 0⋅48 to 1⋅17). Following propensity score matching, IBR only reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (OR 0⋅95, 0⋅90 to 0⋅99), but not within 9 weeks (OR 0⋅97, 0⋅95 to 1⋅00) or 12 weeks (OR 1⋅00, 0⋅99 to 1⋅01).Conclusion: Postmastectomy IBR marginally reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks, but not within 9 or 12 weeks. Thus, IBR is not contraindicated in patients who need adjuvant chemotherapy after mastectomy.

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“…Overall and positive lymph node yields were similar (NACT 13 and 3 vs ACT 14 and 4), suggesting that NACT rarely obviated ALND or downstaged the axilla. Other authors have also demonstrated high rates of persistent nodal involvement in ILC patients that ultimately made ALND unavoidable . In our study, 48.4% of patients who received NACT had T1 or T2 disease suggesting that in these cases, presentation with node‐positive disease may have driven the decision to pursue NACT.…”

Section: Discussionmentioning

confidence: 55%

“…But ILC is also nearly always hormone receptor (HR)‐positive, and previous studies have demonstrated that patients with low‐grade, HR‐positive (HR+) ILC have a poor response to NACT, experiencing lower rates of pathologic complete response (pCR) than patients with IDC . Concomitantly, NACT has historically been less successful in enabling breast conservation or omission of more extensive axillary surgery among ILC patients, who have higher rates of mastectomy and completion axillary lymph node dissection (ALND) than those with IDC . Nevertheless, similar criteria—including nodal involvement—are used to determine whether NACT should be administered in both histologic subtypes …”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] Concomitantly, NACT has historically been less successful in enabling breast conservation or omission of more extensive axillary surgery among ILC patients, who have higher rates of mastectomy and completion axillary lymph node dissection (ALND) than those with IDC. [8][9][10][11] Nevertheless, similar criteria-including nodal involvement-are used to determine whether NACT should be administered in both histologic subtypes. 12 Data from several clinical trials and population-based studies report an association between pCR and improved survival, though some studies have also demonstrated that the lower pCR rates seen in ILC patients do not necessarily correlate with worse outcomes.…”

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confidence: 99%

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The impact of chemotherapy sequence on survival in node‐positive invasive lobular carcinoma

Tamirisa

Williamson

Thomas

et al. 2019

Journal of Surgical Oncology

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Background and Objectives We sought to evaluate the impact of chemotherapy sequence on survival by comparing node‐positive invasive lobular carcinoma (ILC) patients who received neoadjuvant (NACT) and adjuvant (ACT) chemotherapy. Methods cT1‐4c, cN1‐3 ILC patients in the National Cancer Data Base (2004‐2013) who underwent surgery and chemotherapy were divided into NACT and ACT cohorts. Kaplan‐Meier curves and Cox proportional hazards modeling were used to estimate unadjusted and adjusted overall survival (OS), respectively. Results Five thousand five hundred fifty‐one (35.6%) of 15 573 ILC patients treated with chemotherapy received NACT. NACT patients had similar rates of pT3/4 disease (26.6% vs 26.2%), nodal involvement (median 3 vs 4), and number of lymph nodes examined (median 13 vs 14) but higher rates of mastectomy (81.8% vs 74.5%, P < 0.001) vs ACT patients. 3.4% of NACT patients experienced pathologic complete response (pCR). Unadjusted 10‐year OS was worse for NACT vs ACT patients (65.1% vs 54.4%, log‐rank P < 0.001). After adjustment for known covariates, NACT continued to be associated with worse OS (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.25‐1.52). Conclusions In node‐positive ILC, NACT yielded low rates of pCR, was not associated with lower rates of mastectomy or less extensive axillary surgery, and was associated with worse survival vs ACT, suggesting limited benefit for these patients.

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Trends on Axillary Surgery in Nondistant Metastatic Breast Cancer Patients Treated Between 2011 and 2015

Cited by 62 publications

References 27 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

Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy

The impact of chemotherapy sequence on survival in node‐positive invasive lobular carcinoma

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