Can the eligibility criteria of the ACOSOG Z0011 trial be extended to patients undergoing mastectomy and presenting T3-T4 tumors? An analysis of non-sentinel axillary metastases

2020 ◽  
Author(s):  
F Riedel ◽  
J Heil ◽  
M Feißt ◽  
M Moderow ◽  
A von Au ◽  
...  
Keyword(s):  
Axillary Metastases ◽  
Eligibility Criteria ◽  
Acosog Z0011 ◽  
Z0011 Trial

scholarly journals Analyzing non-sentinel axillary metastases in patients with T3–T4 cN0 early breast cancer and tumor-involved sentinel lymph nodes undergoing breast-conserving therapy or mastectomy

2020 ◽  
Vol 184 (2) ◽  
pp. 627-636
Author(s):  
Fabian Riedel ◽  
Joerg Heil ◽  
Manuel Feisst ◽  
Mareike Moderow ◽  
Alexandra von Au ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Early Breast Cancer ◽  
Tumor Burden ◽  
Sentinel Lymph Nodes ◽  
Axillary Lymph ◽  
Axillary Metastases ◽  
Eligibility Criteria ◽  
Acosog Z0011 ◽  
Z0011 Trial

Abstract Purpose In the ACOSOG Z0011 trial, completing axillary lymph node dissection (cALND) did not benefit patients with T1–T2 cN0 early breast cancer and 1–2 positive sentinel lymph nodes (SLN) undergoing breast-conserving surgery (BCT). This paper reports cALND rates in the clinical routine for patients who had higher (T3–T4) tumor stages and/or underwent mastectomy but otherwise met the ACOSOG Z0011 eligibility criteria. Aim of this study is to determine cALND time trends and non-sentinel axillary metastases (NSAM) rates to estimate occult axillary tumor burden. Methods Data were included from patients treated in 179 German breast cancer centers between 2008 and 2015. Time-trend rates were analyzed for cALND of patients with T3–T4 tumors separated for BCT and mastectomy and regarding presence of axillary macrometastases or micrometastases. Results Data were available for 188,909 patients, of whom 19,009 were identified with 1–2 positive SLN. Those 19,009 patients were separated into 4 cohorts: (1) Patients with T1–T2 tumors receiving BCT (ACOSOG Z0011 eligible; n = 13,741), (2) T1–T2 with mastectomy (n = 4093), (3) T3–T4 with BCT (n = 269), (4) T3–T4 with mastectomy (n = 906). Among patients with T3–T4 tumors, cALND rates declined from 2008 to 2015: from 88.2 to 62.6% for patients receiving mastectomy and from 96.6 to 58.1% in patients receiving BCT. Overall rates for any NSAM after cALND for cohorts 1–4 were 33.4%, 42.3%, 46.9%, 58.8%, respectively. Conclusions The cALND rates have decreased substantially in routine care in patients with ‘extended’ ACOSOG Z0011 eligibility criteria. Axillary tumor burden is higher in these patients than in the ACOSOG Z0011 trial.

Applicability of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial results in invasive lobular carcinoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1103-1103
Author(s):  
Jun Wang ◽  
Elizabeth Ann Mittendorf ◽  
Aysegul A. Sahin ◽  
Min Yi ◽  
Abigail Suzanne Caudle ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Invasive Lobular Carcinoma ◽  
Lobular Carcinoma ◽  
Node Dissection ◽  
Oncology Group ◽  
Eligibility Criteria ◽  
Acosog Z0011 ◽  
American College Of Surgeons ◽  
Z0011 Trial

1103 Background: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated that, for patients with clinical T1-T2, N0 breast cancer and one or two positive sentinel lymph nodes undergoing breast conserving therapy, there was no difference in local-regional recurrence (LRR), disease-free survival or overall survival (OS) between patients who underwent sentinel lymph node dissection (SLND) alone or completion axillary lymph node dissection (ALND). However, there were a limited number of invasive lobular carcinoma (ILC) participants (7%) in the study. In addition, it is known that ILC has a different pattern of metastases, frequently presenting as small foci requiring immunohistochemistry for detection. Together, these considerations raise concern regarding the applicability of the ACOSOG Z0011 data to patients with ILC. Methods: Patients with ILC who met the ACOSOG Z0011 eligibility criteria were identified from the Surveillance, Epidemiology, and End Results database (1998-2009). Patients were evaluated based on the extent of axillary surgery: SLND alone or ALND. Clinicaloutcomes of the two groups were compared. Results: At a median follow-up of 71 months, there were no LRRs in the SLND arm, and only 4 (0.45%) in the ALND arm. There were no differences in OS or disease-specific survival between the two groups. Conclusions: Omission of completion ALND is appropriate in patients with ILC who fulfill the ACOSOG Z0011 eligibility criteria.

To Do or Not to Do: Axillary Nodal Evaluation after ACOSOG Z0011 Trial

Radiographics ◽  
2014 ◽  
Vol 34 (7) ◽  
pp. 1807-1816 ◽  
Author(s):  
Kathryn L. Humphrey ◽  
Mansi A. Saksena ◽  
Phoebe E. Freer ◽  
Barbara L. Smith ◽  
Elizabeth A. Rafferty
Keyword(s):  
Acosog Z0011 ◽  
Z0011 Trial

Economic implications of ACOSOG Z0011 trial application into clinical practice at the European Institute of Oncology

2021 ◽  
Author(s):  
Denise Mattar ◽  
Antonio Di Filippo ◽  
Alessandra Invento ◽  
Davide Radice ◽  
Marius Burcuta ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Economic Implications ◽  
Acosog Z0011 ◽  
European Institute ◽  
Z0011 Trial

ASO Visual Abstract: The Attitudes of Brazilian Breast Surgeons on Axillary Management in Early Breast Cancer 10 Years After the ACOSOG Z0011 Trial First Publication

2021 ◽  
Author(s):  
Eduardo Camargo Millen ◽  
Francisco Pimentel Cavalcante ◽  
Felipe Zerwes ◽  
Guilherme Novita ◽  
Alessandra Borba Anton de Souza ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Acosog Z0011 ◽  
Z0011 Trial

AB059. 228. The impact of ACOSOG Z0011 trial on axillary management of breast cancer in the Galway University Hospitals

2018 ◽  
Vol 2 ◽  
pp. AB059-AB059
Author(s):  
Ellen O’Beirne ◽  
Peter McAnena ◽  
Ishwarya Balasubramanian ◽  
Aoife Lowery ◽  
Michael Kerin
Keyword(s):  
Breast Cancer ◽  
University Hospitals ◽  
Acosog Z0011 ◽  
Z0011 Trial ◽  
The Impact

Avoidance of axillary dissection in cN0 breast cancer patients with metastatic sentinel lymph node(s) using ACOSOG Z-0011 criteria: Is it appropriate for Indian patients?

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 62-62
Author(s):  
Gaurav Agarwal ◽  
Sanjay Gambhir ◽  
Punita Lal ◽  
Narendra Krishnani ◽  
Sendhil Rajan
Keyword(s):  
False Negative ◽  
Study Cohort ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Single Institution ◽  
Data Set ◽  
Entire Study ◽  
Acosog Z0011 ◽  
Tangential Field ◽  
Z0011 Trial

62 Background: A relatively newer algorithm for surgical management of axilla, where axillary node dissection (ALND) is avoided in cN0 EBC patients with 1 to 2 metastatic sentinel nodes (SLN) is now widely practiced in North America. ASCO & NCCN guidelines, and St Gallen consensus statement too have endorsed this strategy. This algorithm, based on the ACOSOG-Z0011 trial results has evoked quite a debate in India too. Concerns relating the quality of Z0011 data and its wide applicability persist. On the other hand, avoidance of ALND and its morbidity seems attractive to the oncologists and patients. In a single institution validation SLN Biopsy (SLNB) data-set, we evaluated the applicability of the “Z0011 strategy” to know its impact on an Indian patient cohort. Methods: In a prospective data-set of 120 cN0 EBC patients (mean age 51.1 years, T1 = 14, T2 = 106, mean tumor size 3.8 cm, 51.7% ER/PR+) who underwent validation SLNB (ALND irrespective of SLNB histology), such patients who fulfilled the selection criteria of ACOSOG-Z0011, i.e. those who underwent BCS and tangential field whole breast irradiation, and 1-2 metastatic SLNs were identified. Results: 66 (55%) of the 120 patients underwent BCS and tangential field whole breast irradiation. Of the 25 out of 66 patients with metastatic SLNs, 5 patients had 3 or more metastatic SLNs, and 2 had extra-nodal spread, thus not fitting the Z0011 criteria. Thus only 18 patients (15% of entire study cohort, and 27.3% of those undergoing BCS) with 1 to 2 metastatic SLNs were eligible for avoidance of ALND based Z0011 criteria. Of these 18 eligible patients, 7 (38.9%) had non-sentinel metastatic nodes. These 7, and the 3 with false negative SLNs could be seen as being left with undertreated axillae. Conclusions: In Indian context, where the majority of patients have large tumors and many opt for mastectomy, avoidance of ALND in presence of metastatic SLNs can be offered to a small proportion of patients. In a single institution validation SLNB data-set, only 15% patients qualified for avoidance of ALND using the Z0011 trial criteria. Besides, avoidance of ALND would have left 8.3% patients potentially undertreated in the axilla.

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