Nodal Irradiation AFTER SNB

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 established.

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.

Further studies 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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