title: [Impact of omission of axillary dissection on adjuvant therapy in patients with metastatic sentinel lymph nodes according to the ACOSOG Z0011 criteria].
abstract: OBJECTIVE
  The results of the ACOSOG Z0011 questioned the usefulness of axillary lymph node dissection (ALND) in case of metastatic sentinel lymph node (SLN). The aim of our study was to assess the impact of the omission of ALND according to the inclusion criteria of the ACOSOG Z0011 study if SLN are metastatic but also the consequences on prescription of the application of a new standard of care for adjuvant treatment.
  
  
  METHODS
  This retrospective study included, between November 2007 and January 2012, patients with T1-T2N0 breast cancer and metastatic SLN meeting the criteria for omission of completion ALND according to the study of the ACOSOG Z0011. Patients were submitted anonymously and randomly in multidisciplinary meeting (MM) 3 times: with complete information including ALND (MM1), with information from SLN alone (MM2) and with complete information of ALND according to the current protocols in 2013 (MM3). During each presentation, we collected the decision of the different adjuvant treatments proposed: chemotherapy, hormonal therapy, radiotherapy (with radiation fields). Then, we compared therapeutic proposals of the 3 presentations.
  
  
  RESULTS
  Fifty-eight patients were eligible for inclusion criteria of the ACOSOG Z0011. Treatments actually proposed during MM1 consisted of 94.8 % of chemotherapy, 77.6 % of breast and lymph nodes radiotherapy and 91.4 % of hormone therapy. During the MM2, there was no significant difference compared to the decision taken during MM1. In fact, during MM2, we decided chemotherapy, radiotherapy and hormonotherapy respectively in 89.7, 79.3 and 91.4 % of the cases. During the MM3, it was shown a significant decrease in the indications of chemotherapy (82.8 %, P=0.03) and lymph nodes irradiation (56.9 %, P=0.02) compared to the therapeutic proposals of the MM1.
  
  
  CONCLUSIONS
  The lack of information of ALND does not seem to significantly alter indications for adjuvant treatment. Otherwise, the evolution of our references causes a decrease in adjuvant therapy.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Jean-Verdier, AP-HP, université de Bobigny, avenue du 14-Juillet, 93143 Bondy, France.
authors.forename: A
authors.initials: A
authors.lastname: Roosen
authors.affiliation: Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, Sorbonne Paris Cité, université Paris Diderot, 2, rue Ambroise-Paré, 75010 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Lousquy
authors.affiliation: Service de gynécologie-obstétrique, hôpital Jean-Verdier, AP-HP, université de Bobigny, avenue du 14-Juillet, 93143 Bondy, France.
authors.forename: A
authors.initials: A
authors.lastname: Bricou
authors.affiliation: Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, Sorbonne Paris Cité, université Paris Diderot, 2, rue Ambroise-Paré, 75010 Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Delpech
authors.affiliation: Service de radiothérapie, hôpital Saint-Louis, AP-HP, Sorbonne Paris Cité, université Paris Diderot, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Selz
authors.affiliation: Service d'oncologie médicale, hôpital Saint-Louis, AP-HP, Sorbonne Paris Cité, université Paris Diderot, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Le Maignan
authors.affiliation: Service d'oncologie médicale, hôpital Saint-Louis, AP-HP, Sorbonne Paris Cité, université Paris Diderot, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Bousquet
authors.affiliation: Service d'oncologie médicale, hôpital Avicenne, AP-HP, université de Bobigny, 125, rue de Stalingrad, 93009 Bobigny, France.
authors.forename: S
authors.initials: S
authors.lastname: Winterman
authors.affiliation: Service d'oncologie médicale, hôpital Avicenne, AP-HP, université de Bobigny, 125, rue de Stalingrad, 93009 Bobigny, France.
authors.forename: L
authors.initials: L
authors.lastname: Zelek
authors.affiliation: Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, Sorbonne Paris Cité, université Paris Diderot, 2, rue Ambroise-Paré, 75010 Paris, France; Pôle de chirurgie oncologique générale, gynécologique et mammaire, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France. Electronic address: emmanuel.barranger@nice.unicancer.fr.
authors.forename: E
authors.initials: E
authors.lastname: Barranger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome
keywords: ACOSOG; Adjuvant therapy; Breast cancer; Cancer du sein; Ganglion sentinelle; Sentinel lymph node; Traitement adjuvant