title: Primary tumor response to induction chemotherapy as a predictor of histological status of axillary nodes in operable breast cancer patients.
abstract: BACKGROUND
  Routine use of axillary lymph node dissection is being questioned, especially in clinically NO patients. The goal of this study was to determine whether primary tumor response to induction chemotherapy (IC) can predict the histological volume of residual axillary disease in patients who were candidates for breast conservation surgery after IC.
  
  
  METHODS
  Forty-seven patients with stage II or IIIA breast cancer who received breast conservation surgery were selected from a population of patients randomized to receive four cycles of IC. Largest clinical tumor size before and after IC was determined by physical examination, mammography, and breast ultrasound. Clinical nodal status was determined by physical examination and axillary ultrasound and compared with histological findings.
  
  
  RESULTS
  In patients with at least 50% reduction in primary tumor size after IC, 12 of 14 (86%) NO patients and 11 of 17 (65%) N1 patients were histologically negative. In patients with a less than 50% reduction, 0 of 3 NO patients and 2 of 13 (15%) N1 patients were histologically negative.
  
  
  CONCLUSIONS
  There is significantly less axillary disease in responders than in nonresponders after IC. For NO responders, axillary irradiation may be an acceptable alternative to axillary lymph node dissection, and could easily be incorporated into the postsurgical radiotherapy that is standard protocol for breast conservation therapy. The more aggressive disease in nonresponders is best treated by axillary lymph node dissection, pending further study.
authors.affiliation: Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Lenert
authors.forename: G
authors.initials: G
authors.lastname: Vlastos
authors.forename: N Q
authors.initials: NQ
authors.lastname: Mirza
authors.forename: D J
authors.initials: DJ
authors.lastname: Winchester
authors.forename: S M
authors.initials: SM
authors.lastname: Binkley
authors.forename: F C
authors.initials: FC
authors.lastname: Ames
authors.forename: M I
authors.initials: MI
authors.lastname: Ross
authors.forename: B W
authors.initials: BW
authors.lastname: Feig
authors.forename: K K
authors.initials: KK
authors.lastname: Hunt
authors.forename: E
authors.initials: E
authors.lastname: Strom
authors.forename: A U
authors.initials: AU
authors.lastname: Buzdar
authors.forename: G N
authors.initials: GN
authors.lastname: Hortobagyi
authors.forename: S E
authors.initials: SE
authors.lastname: Singletary
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011237:Predictive Value of Tests