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Erschienen in: Annals of Surgical Oncology 3/2017

03.10.2016 | Breast Oncology

Outcomes of Sentinel Lymph Node-Positive Breast Cancer Patients Treated with Mastectomy Without Axillary Therapy

verfasst von: Elizabeth FitzSullivan, MD, Roland L. Bassett, MS, Henry M. Kuerer, MD, PhD, Elizabeth A. Mittendorf, MD, PhD, Min Yi, MD, PhD, Kelly K. Hunt, MD, Gildy V. Babiera, MD, Abigail S. Caudle, MD, Dalliah M. Black, MD, Isabelle Bedrosian, MD, Chantal Reyna, MD, Mediget Teshome, MD, Funda Meric-Bernstam, MD, Rosa Hwang, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 3/2017

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Abstract

Purpose

Early-stage breast cancer patients with minimal axillary disease identified by sentinel lymph node dissection (SLND) have low regional recurrence rates when treated with breast-conserving surgery and radiation therapy (XRT) and many avoid a completion axillary lymph node dissection (CLND). As the incidence of total mastectomy (TM) has increased, it has become important to characterize which TM patients with a positive SLN may not benefit from further axillary treatment.

Methods

An institutional database was utilized to identify patients treated with a TM for invasive breast cancer and who had a positive SLN from 1994 to 2010. Clinicopathologic factors were analyzed. Regional recurrence rate, recurrence-free survival (RFS), and overall survival (OS) were determined.

Results

A total of 525 patients with invasive breast cancer and a positive SLN were treated with TM, including 58 patients who did not have CLND or XRT and 12 patients who did not have CLND but did receive XRT. Median follow-up was 66 months. The incidence of regional recurrence was not significantly different for patients who received no further axillary treatment compared to those who underwent CLND without XRT or those treated with XRT without CLND (10 years rate: 3.8 vs. 1.6 and 0 % respectively). RFS and OS were not significantly different among patients who received no further axillary treatment compared to those who underwent CLND, XRT, or both.

Conclusions

In select patients with early-stage breast cancer treated with mastectomy with a positive SLN, CLND may be avoided without adversely affecting recurrence or survival.
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Literatur
1.
Zurück zum Zitat Peintinger F, Reitsamer R, Stranzl H, Ralph G. Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients. Br J Cancer. 2003;89(4):648-52.CrossRefPubMedPubMedCentral Peintinger F, Reitsamer R, Stranzl H, Ralph G. Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients. Br J Cancer. 2003;89(4):648-52.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Blanchard DK, Donohue JH, Reynolds C, Grant CS. Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer. Arch Surg. 2003;138(5):482-7; discussion 487-8.CrossRefPubMed Blanchard DK, Donohue JH, Reynolds C, Grant CS. Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer. Arch Surg. 2003;138(5):482-7; discussion 487-8.CrossRefPubMed
3.
Zurück zum Zitat Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426-32; discussion 432-3.PubMed Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426-32; discussion 432-3.PubMed
4.
Zurück zum Zitat Baruch AC, Wang H, Staerkel GA, Evans DB, Hwang RF, Krishnamurthy S. Immunocytochemical study of the expression of mesothelin in fine-needle aspiration biopsy specimens of pancreatic adenocarcinoma. Diagn Cytopathol. 2007;35(3):143-7.CrossRefPubMed Baruch AC, Wang H, Staerkel GA, Evans DB, Hwang RF, Krishnamurthy S. Immunocytochemical study of the expression of mesothelin in fine-needle aspiration biopsy specimens of pancreatic adenocarcinoma. Diagn Cytopathol. 2007;35(3):143-7.CrossRefPubMed
5.
Zurück zum Zitat Cyr A, Gao F, Gillanders WE, Aft RL, Eberlein TJ, Margenthaler JA. Disease recurrence in sentinel node-positive breast cancer patients forgoing axillary lymph node dissection. Ann Surg Oncol. 2012;19(10):3185-91.CrossRefPubMedPubMedCentral Cyr A, Gao F, Gillanders WE, Aft RL, Eberlein TJ, Margenthaler JA. Disease recurrence in sentinel node-positive breast cancer patients forgoing axillary lymph node dissection. Ann Surg Oncol. 2012;19(10):3185-91.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Bilimoria KY, Bentrem DJ, Hansen NM, et al. Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol. 2009;27(18):2946-53.CrossRefPubMed Bilimoria KY, Bentrem DJ, Hansen NM, et al. Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol. 2009;27(18):2946-53.CrossRefPubMed
7.
Zurück zum Zitat Naik AM, Fey J, Gemignani M, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg. 2004;240(3):462-8; discussion 468-71.CrossRefPubMedPubMedCentral Naik AM, Fey J, Gemignani M, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg. 2004;240(3):462-8; discussion 468-71.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471-4.CrossRefPubMed Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471-4.CrossRefPubMed
10.
Zurück zum Zitat Mittendorf EA, Hunt KK, Boughey JC, et al. Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg. 2012;255(1):109-15.CrossRefPubMedPubMedCentral Mittendorf EA, Hunt KK, Boughey JC, et al. Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg. 2012;255(1):109-15.CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297-305.CrossRefPubMedPubMedCentral Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297-305.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Milgrom S, Cody H, Tan L, et al. Characteristics and outcomes of sentinel node-positive breast cancer patients after total mastectomy without axillary-specific treatment. Ann Surg Oncol. 2012;19(12):3762-70.CrossRefPubMed Milgrom S, Cody H, Tan L, et al. Characteristics and outcomes of sentinel node-positive breast cancer patients after total mastectomy without axillary-specific treatment. Ann Surg Oncol. 2012;19(12):3762-70.CrossRefPubMed
13.
Zurück zum Zitat Snow R, Reyna C, Johns C, et al. Outcomes with and without axillary node dissection for node-positive lumpectomy and mastectomy patients. Am J Surg. 2015;210(4):685–93.CrossRefPubMed Snow R, Reyna C, Johns C, et al. Outcomes with and without axillary node dissection for node-positive lumpectomy and mastectomy patients. Am J Surg. 2015;210(4):685–93.CrossRefPubMed
14.
Zurück zum Zitat Yao K, Liederbach E, Pesce C, Wang CH, Winchester DJ. Impact of the American College of Surgeons Oncology Group Z0011 Randomized Trial on the number of axillary nodes removed for patients with early-stage breast cancer. J Am Coll Surg. 2015;221(1):71-81.CrossRefPubMed Yao K, Liederbach E, Pesce C, Wang CH, Winchester DJ. Impact of the American College of Surgeons Oncology Group Z0011 Randomized Trial on the number of axillary nodes removed for patients with early-stage breast cancer. J Am Coll Surg. 2015;221(1):71-81.CrossRefPubMed
15.
Zurück zum Zitat Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-61.CrossRefPubMedPubMedCentral Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-61.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Garg AK, Buchholz TA. Influence of neoadjuvant chemotherapy on radiotherapy for breast cancer. Ann Surg Oncol. 2015;22(5):1434-40.CrossRefPubMed Garg AK, Buchholz TA. Influence of neoadjuvant chemotherapy on radiotherapy for breast cancer. Ann Surg Oncol. 2015;22(5):1434-40.CrossRefPubMed
Metadaten
Titel
Outcomes of Sentinel Lymph Node-Positive Breast Cancer Patients Treated with Mastectomy Without Axillary Therapy
verfasst von
Elizabeth FitzSullivan, MD
Roland L. Bassett, MS
Henry M. Kuerer, MD, PhD
Elizabeth A. Mittendorf, MD, PhD
Min Yi, MD, PhD
Kelly K. Hunt, MD
Gildy V. Babiera, MD
Abigail S. Caudle, MD
Dalliah M. Black, MD
Isabelle Bedrosian, MD
Chantal Reyna, MD
Mediget Teshome, MD
Funda Meric-Bernstam, MD
Rosa Hwang, MD
Publikationsdatum
03.10.2016
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 3/2017
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5605-5

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