title: Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node Metastases: Long-term Follow-up From the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial.
abstract: OBJECTIVE
  The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLNs) randomized either to axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. We now report long-term locoregional recurrence results.
  
  
  METHODS
  ACOSOG Z0011 prospectively examined overall survival of patients with SLN metastases undergoing breast-conserving therapy randomized to undergo ALND after SLND or no further axillary specific treatment. Locoregional recurrence was prospectively evaluated and compared between the groups.
  
  
  RESULTS
  Four hundred forty-six patients were randomized to SLND alone and 445 to SLND and ALND. Both groups were similar with respect to age, Bloom-Richardson score, Estrogen Receptor status, adjuvant systemic therapy, histology, and tumor size. Patients randomized to ALND had a median of 17 axillary nodes removed compared with a median of only 2 SLNs removed with SLND alone (P < 0.001). ALND, as expected, also removed more positive lymph nodes (P < 0.001). At a median follow-up of 9.25 years, there was no statistically significant difference in local recurrence-free survival (P = 0.13). The cumulative incidence of nodal recurrences at 10 years was 0.5% in the ALND arm and 1.5% in the SLND alone arm (P = 0.28). Ten-year cumulative locoregional recurrence was 6.2% with ALND and 5.3% with SLND alone (P = 0.36).
  
  
  CONCLUSIONS
  Despite the potential for residual axillary disease after SLND, SLND without ALND offers excellent regional control for selected patients with early metastatic breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.
authors: *Cedars Sinai Medical Center, Los Angeles, CA †Alliance Statistics and Data Center, Weill Cornell Medicine/New York Presbyterian, New York, NY ‡Alliance Statistics and Data Center, Duke University, Durham, NC §Dallas Surgical Group, Dallas, TX ¶Nashville Breast Center, Nashville, TN ||Morton Plant Hospital, Clear Water, FL **University of Texas Southwestern Medical Center Surgery, Dallas, TX ††McLaren Regional Medical Center, Michigan State University, Flint, MI ‡‡Memorial Sloan-Kettering Cancer Center, New York, NY §§MD Anderson Cancer Center, Houston, TX.
authors: Armando E
authors: AE
authors: Giuliano
authors: Karla
authors: K
authors: Ballman
authors: Linda
authors: L
authors: McCall
authors: Peter
authors: P
authors: Beitsch
authors: Pat W
authors: PW
authors: Whitworth
authors: Peter
authors: P
authors: Blumencranz
authors: A Marilyn
authors: AM
authors: Leitch
authors: Sukamal
authors: S
authors: Saha
authors: Monica
authors: M
authors: Morrow
authors: Kelly K
authors: KK
authors: Hunt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011446:Prospective Studies; D000071036:Sentinel Lymph Node / Q000601:surgery