Management of the Axilla in T1-2 Breast Cancer Patients with Macrometastatic Sentinel Node Involvement Who Underwent Breast-Conserving Therapy

Kuru, Bekir; Yürüker, Savaş; Süllü, Yüksel; Gursel, Bilge; Özen, Nurten

doi:10.1080/08941939.2017.1375051

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…In the study by Kuru et al (54), patients with 1-2 metastases on SLNB without ENE were assigned to the SLNB-only plus radiotherapy for the axillary levels I-III and to supraclavicular fossa or ALND groups (plus radiotherapy for undissected axillary level III and to the supraclavicular fossa). However, contrary to the randomised trials micrometastases were not included in this study, and all patients had macrometastases on the SLNB (66)(67)(68)(69).This study also showed that lymphoedema and arm morbidity were significantly lower in SLNB-only arm compared with the ALND arm (54).…”

Section: Axillary Treatment In Patients With Metastasis On Sentinel Lmentioning

confidence: 55%

“…Many retrospective studies which reported the outcomes in patients with positive SLNB have observed no axillary recurrences (51)(52)(53)(54) or between 0.2% and 1.7% in patients with SLNB alone (Table 3) (34,55,56). The others which compared the outcomes after SLNB alone with completion ALND demonstrated that the axillary recurrence rate was ≤2% (Table 3) (43,57,58).…”

Section: Axillary Treatment In Patients With Metastasis On Sentinel Lmentioning

confidence: 99%

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The Adventure of Axillary Treatment in Early Stage Breast Cancer

Kuru

2020

Eur J Breast Health

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Axillary lymph node dissection (ALND) which was an essential part of breast cancer treatment and the gold standard in evaluation of the status of axillary lymph node had notorious with increased arm morbidity and reduction of quality of life. Sentinel lymph node biopsy (SLNB) accurately stages the axilla in early breast cancer and ALND is omitted in SLNB negative patients. In patients with positive SLNB the omission of ALND with or without replacement of axillary radiotherapy has also been recommended by guidelines. The neoadjuvant chemotherapy (NAC) which has been increasingly used for large breast cancers to downstage the tumours for allowing breast conserving surgery and decreasing mastectomy rate has also been used in axillary node positive patients to reduce the need for ALND. The issues surrounding the treatment of axilla in patients treated with NAC; application and false negative rate of SLNB, number of identified sentinel lymph nodes, and axillary radiotherapy instead of ALND are currently the discussed and practiced hot topics. The quests for decreasing arm morbidity without compromising outcome in breast cancer treatment which have begun with the invention of SLNB continue for axilla conserving surgery. This article reviews the adventure of axillary treatment in breast cancer patients treated with or without NAC.

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Section: Axillary Treatment In Patients With Metastasis On Sentinel Lmentioning

confidence: 55%

Section: Axillary Treatment In Patients With Metastasis On Sentinel Lmentioning

confidence: 99%

The Adventure of Axillary Treatment in Early Stage Breast Cancer

Kuru

2020

Eur J Breast Health

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“…The suggested treatment strategy for positive SLNs on SLNB involves wholebreast radiation with or without adjuvant chemotherapy [30]. Even more, studies suggest that for macrometastasis, treatment may be restricted to whole-breast radiotherapy (targeting all three levels of the axilla) and/or systemic treatment while omitting ALND [9,31]. Kuru et.…”

Section: Nodal Disease Status Comparabilitymentioning

confidence: 99%

“…Kuru et. al reports minimal rates of axillary recurrence, lymphedema, and shoulder restriction with the latter approach [9]. The Z0011 trial is considered the most in uential study when it comes the management of macroscopic axillary nodal metastasis given the high prevalence of macro-metastasis versus a modest 35% micro-metastasis rate in their cohort of early breast cancer patients [31,32].…”

Section: Nodal Disease Status Comparabilitymentioning

confidence: 99%

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Patterns of management of positive sentinel lymph nodes in breast cancer patients after the American College of Surgeons Oncology Group Z0011 trial: a retrospective cohort

Charif

Ghezzawi

Kalot

et al. 2023

Preprint

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Purpose The ACOSOG-Z0011 clinical trial introduced drastic changes to the traditional surgical practice for early breast cancer with positive sentinel lymph nodes. This study evaluates how these changes have affected the surgical management of early breast cancer at our institution. Methods A retrospective chart review was conducted for Lebanese women with a diagnosis of invasive breast cancer and who were ≥18 years of age, had undergone upfront breast-conserving surgery, and SLNB without any prior chemotherapy had no distant metastasis and had one or more positive SLNs, between 2011 and 2016. Results Data from our cohort shows that 78% of patients out of the 233 with clinically negative nodes go on to have negative nodes on surgical sentinel pathology as well. However, the incidence of micromets is 5.5% amongst positive SLNs versus 94% of positive SLNs having macromets. Survival data analysis showed a 5-year and 10-year locoregional recurrence rates of 1.72% and 2.15%, respectively. At 3-years follow-up, distant metastasis occurred in 3.4% of cases. Additionally, the 10-year overall survival is 98.7% and disease-free survival is 95.3%. The rates of ALND decreased from 46.7% to 18.2% in patients with 2 or less positive sentinel nodes between the two time periods 2011-2013 and 2014-2016. Conclusion With a follow-up period extending more than five years, our study shows that ALND offers no superiority to SLNB alone in terms of overall survival and disease-free survival. This does not only conform with the findings of Z0011 but adds to its generalizability to populations of different ethnicities.

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