Limits...
Targeting and limiting surgery for patients with node-positive breast cancer.

Caudle AS, Kuerer HM - BMC Med (2015)

Bottom Line: Historically, all node-positive patients underwent complete axillary lymph node dissection; however, this paradigm has changed over the last 10 years.Clinically node-negative patients with small volume disease found on sentinel lymph node dissection now commonly avoid more extensive axillary surgery.There is interest in expanding this role to node-positive patients who receive neoadjuvant chemotherapy as a way to restage the axilla in hopes of sparing women who convert to node-negative status from the morbidity of complete nodal clearance.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit1484, Houston, TX, 77230-1402, USA. ascaudle@mdanderson.org.

ABSTRACT
The presence of axillary nodal metastases has a significant impact on locoregional and systemic treatment decisions. Historically, all node-positive patients underwent complete axillary lymph node dissection; however, this paradigm has changed over the last 10 years. The use of sentinel lymph node dissection has expanded from its initial role as a surgical staging procedure in clinically node-negative patients. Clinically node-negative patients with small volume disease found on sentinel lymph node dissection now commonly avoid more extensive axillary surgery. There is interest in expanding this role to node-positive patients who receive neoadjuvant chemotherapy as a way to restage the axilla in hopes of sparing women who convert to node-negative status from the morbidity of complete nodal clearance. While sentinel lymph node dissection alone may not accomplish this goal, there are novel techniques, such as targeted axillary dissection, that may now allow for reliable nodal staging after chemotherapy.

No MeSH data available.


Related in: MedlinePlus

ACOSOG Z1071 Trial [7]. The ACOSOG Z1071 trial was designed to test the reliability of sentinel lymph node dissection to restage the axillary lymph nodes after neoadjuvant chemotherapy in patients presenting with clinically positive lymph nodes
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4481081&req=5

Fig2: ACOSOG Z1071 Trial [7]. The ACOSOG Z1071 trial was designed to test the reliability of sentinel lymph node dissection to restage the axillary lymph nodes after neoadjuvant chemotherapy in patients presenting with clinically positive lymph nodes

Mentions: The role of SLND in patients who present with clinically involved and biopsy proven lymph nodes and have a clinical response to NCT is currently under review. Since 40–75 % of patients have eradication of their nodal disease [18, 20, 24, 25], there is considerable interest in finding reliable methods to restage the axilla in hope of sparing a significant percentage of patients from the morbidity of ALND. There are concerns, however, that SLND may not be accurate in this setting – single institution reports have shown unacceptably high FNRs of 15–30 % [26–29]. The ACOSOG Z1071 trial was designed to test the hypothesis that SLND performed with a standardized surgical approach would accurately assess nodal response after chemotherapy. The study enrolled women with clinical T0-4 N1-2 M0 breast cancer with nodal metastases confirmed by needle biopsy. After completing neoadjuvant chemotherapy, enrolled patients underwent SLND followed by completion ALND in order to assess the FNR (Fig. 2). The study was designed with a prespecified 10 % success threshold for FNR in these patients. The overall nodal conversion rate was 41.1 %, but the trial confirmed previous reports that tumor biology reflected in receptor subtype influenced the probability of nodal conversion [24]. While only 21.1 % (67/317) of patients with hormone-positive disease achieved a nodal pCR, 49.4 % (84/170) of patients with triple negative disease and 64.7 % (134 /207) of those with HER2 amplified disease had nodal conversion.Fig. 2


Targeting and limiting surgery for patients with node-positive breast cancer.

Caudle AS, Kuerer HM - BMC Med (2015)

ACOSOG Z1071 Trial [7]. The ACOSOG Z1071 trial was designed to test the reliability of sentinel lymph node dissection to restage the axillary lymph nodes after neoadjuvant chemotherapy in patients presenting with clinically positive lymph nodes
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4481081&req=5

Fig2: ACOSOG Z1071 Trial [7]. The ACOSOG Z1071 trial was designed to test the reliability of sentinel lymph node dissection to restage the axillary lymph nodes after neoadjuvant chemotherapy in patients presenting with clinically positive lymph nodes
Mentions: The role of SLND in patients who present with clinically involved and biopsy proven lymph nodes and have a clinical response to NCT is currently under review. Since 40–75 % of patients have eradication of their nodal disease [18, 20, 24, 25], there is considerable interest in finding reliable methods to restage the axilla in hope of sparing a significant percentage of patients from the morbidity of ALND. There are concerns, however, that SLND may not be accurate in this setting – single institution reports have shown unacceptably high FNRs of 15–30 % [26–29]. The ACOSOG Z1071 trial was designed to test the hypothesis that SLND performed with a standardized surgical approach would accurately assess nodal response after chemotherapy. The study enrolled women with clinical T0-4 N1-2 M0 breast cancer with nodal metastases confirmed by needle biopsy. After completing neoadjuvant chemotherapy, enrolled patients underwent SLND followed by completion ALND in order to assess the FNR (Fig. 2). The study was designed with a prespecified 10 % success threshold for FNR in these patients. The overall nodal conversion rate was 41.1 %, but the trial confirmed previous reports that tumor biology reflected in receptor subtype influenced the probability of nodal conversion [24]. While only 21.1 % (67/317) of patients with hormone-positive disease achieved a nodal pCR, 49.4 % (84/170) of patients with triple negative disease and 64.7 % (134 /207) of those with HER2 amplified disease had nodal conversion.Fig. 2

Bottom Line: Historically, all node-positive patients underwent complete axillary lymph node dissection; however, this paradigm has changed over the last 10 years.Clinically node-negative patients with small volume disease found on sentinel lymph node dissection now commonly avoid more extensive axillary surgery.There is interest in expanding this role to node-positive patients who receive neoadjuvant chemotherapy as a way to restage the axilla in hopes of sparing women who convert to node-negative status from the morbidity of complete nodal clearance.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit1484, Houston, TX, 77230-1402, USA. ascaudle@mdanderson.org.

ABSTRACT
The presence of axillary nodal metastases has a significant impact on locoregional and systemic treatment decisions. Historically, all node-positive patients underwent complete axillary lymph node dissection; however, this paradigm has changed over the last 10 years. The use of sentinel lymph node dissection has expanded from its initial role as a surgical staging procedure in clinically node-negative patients. Clinically node-negative patients with small volume disease found on sentinel lymph node dissection now commonly avoid more extensive axillary surgery. There is interest in expanding this role to node-positive patients who receive neoadjuvant chemotherapy as a way to restage the axilla in hopes of sparing women who convert to node-negative status from the morbidity of complete nodal clearance. While sentinel lymph node dissection alone may not accomplish this goal, there are novel techniques, such as targeted axillary dissection, that may now allow for reliable nodal staging after chemotherapy.

No MeSH data available.


Related in: MedlinePlus