1. Can axillary node dissection be omitted in a subset of patients with low local and regional failure rates?
- Author
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Christina, Barkley, Harold, Burstein, Barbara, Smith, Jennifer, Bellon, Julia, Wong, Michele, Gadd, Alphonse, Taghian, Eric, Winer, James Dirk, Iglehart, Jay, Harris, and Mehra, Golshan
- Subjects
Sentinel Lymph Node Biopsy ,Breast Neoplasms ,Middle Aged ,Prognosis ,Treatment Outcome ,Neoplasm Micrometastasis ,Lymphatic Metastasis ,Axilla ,Humans ,Lymph Node Excision ,Female ,Neoplasm Recurrence, Local ,Follow-Up Studies ,Retrospective Studies - Abstract
Axillary node dissection (ALND) is the standard of care for patients who have a positive sentinel lymph node (SLN) on sentinel lymph node biopsy (SLNB). We sought to identify a low-risk patient population with positive SLN that may not need cALND. We analyzed SLNB for breast cancer at our institutions between 1999 and 2007. We identified 130 patients who had a positive SLN but did not undergo completion ALND. We evaluated clinical data, adjuvant treatment patterns and intermediate locoregional and distant events. The median patient age was 50; 19% had N0(i+) disease, 53% had micrometastatic (N1mi) disease, and 28% had macrometastasis. Eighty-eight percent of patients underwent radiation therapy; 66 patients (51%) had documented nodal radiation (of these 50 were treated with three fields and 14 with high tangents. Local recurrence in the breast occurred in two patients (2%) and nine patients (7%) developed distant metastases; there were no axillary/nodal recurrences. In this highly selected group of patients who had a positive SLNB but did not undergo cALND, we observed no axillary recurrences.
- Published
- 2011