ABSTRACT: Is nodal irradiation necessary in breast cancer patients
with positive sentinel node biopsy without axillary dissection
Purpose/Objective: Recently, the need for axillary dissection
in breast cancer patients without clinical involvement of the
axilla has been questioned.
Sentinel node biopsy (SNB) is a
practical and highly accurate technique for detecting axillary
metastases from breast carcinoma. Patients with negative SNB can
be spared an axillary dissection. However, the appropriate
management of the axilla following a positive SNB is not well
The American College of Surgeons Oncology Group
(ACOSOG) Protocol Z0011 is an ongoing randomized trial designed
to address the need for axillary dissection in patients with a
positive sentinel node.
We performed a retrospective analysis of
patients with positive SNB who had no further surgical treatment
of the axilla.
Results: At a median follow-up of 31.2 months, 2 patients failed
in distant sites only, one patient had simultaneous regional and
distant failure, one patient failed in breast and distantly, and
one failed in the axilla only. The Kaplan-Meier 2 year disease
free survival was 94.8%, and the risk of local or regional recurrence
was estimated to be 1.6%.
There were no disease related deaths.
Conclusions: Axillary irradiation through an addition of a separate
field may not be necessary in patients with a positive sentinel node
who do not undergo further axillary dissection. By observing the
axilla, one might spare the patient of the acute and chronic
sequelae of axillary irradiation or dissection.
with longer follow-up are needed to establish the role of
observation vs. axillary irradiation in patients with a positive SNB.
[11/11/2002; International Journal of Radiation Oncology, Biology, Physics]
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