title: Omission of axillary dissection according to ACOSOG Z0011: impact on adjuvant treatment recommendations.
abstract: OBJECTIVE
  A recent, randomized trial (ACOSOG Z0011) has demonstrated that omission of completion axillary lymph node dissection (ALND) in patients with one or two sentinel lymph node (SLN) metastases treated with breast conserving therapy (BCT) does not have a negative impact on survival. This study evaluates the impact of omitting ALND on adjuvant treatment recommendations.
  
  
  METHODS
  Performing a search of our clinical database, we identified patients meeting the main inclusion and exclusion criteria of ACOSOG Z0011 treated at the University of Heidelberg Breast Center. We performed blinded mock interdisciplinary tumor boards based on patient and tumor characteristics as well as (1) SLN information or (2) final nodal status after ALND. Differences between treatment recommendations were noted and analyzed.
  
  
  RESULTS
  A total of 132 patients were included; 80.3 % of these had one and 19.7 % had two metastatic sentinel nodes with a rate of micrometastases only of 19.7 %, and 39.7 % of patients had additional nonsentinel node metastases upon ALND. Overall, there was a change in adjuvant chemotherapy in 18.2 % of cases. Treatment recommendations based on ALND lead to a more aggressive therapy in 16.6 % of cases, all of them with additional metastatic nonsentinel nodes. Chemotherapy was not recommended in only two cases (1.5 %) based on ALND. Based on ALND, irradiation of the supraclavicular and infraclavicular nodes was added in 5.3 % of patients.
  
  
  CONCLUSIONS
  Completion ALND for patients with one or two metastatic sentinel nodes in pT1-2 cN0 PBC treated with BCT does have a relevant impact on adjuvant treatment. This should be considered in shared decision making.
authors: Department of Obstetrics and Gynecology, University Hospital, Heidelberg, Germany.
authors: Julia
authors: J
authors: Aigner
authors: Katharina
authors: K
authors: Smetanay
authors: Holger
authors: H
authors: Hof
authors: Hans-Peter
authors: HP
authors: Sinn
authors: Christof
authors: C
authors: Sohn
authors: Andreas
authors: A
authors: Schneeweiss
authors: Frederik
authors: F
authors: Marmé
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D061206:Neoplasm Micrometastasis; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant; D011960:Receptors, Estrogen / Q000378:metabolism; D021701:Sentinel Lymph Node Biopsy
chemical_list: D011960:Receptors, Estrogen