Eight-year follow up result of the OTOASOR trial: The Optimal Treatment Of the Axilla – Surgery Or Radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer

Sávolt, Ákos; Péley, Gábor; Polgár, Csaba; Udvarhelyi, Nóra; Rubovszky, Gábor; Kovács, Eszter; Győrffy, Balázs; Kásler, Miklós; Mátrai, Zoltán

doi:10.1016/j.ejso.2016.12.011

Cited by 222 publications

(98 citation statements)

References 25 publications

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“…To validate the Z0011 strategy using the SEER dataset, we operationally defined the SLND group as having ≤2 ALNs. This allowed us to select patients who underwent SLND alone, with minimal inclusion of patients who underwent conventional ALND, as SLND removes an average of two LNs in most studies [6][7][8]. However, relative to patients who truly underwent SLND alone, patients in our SLND group might be more susceptible to recurrence and/or cancer-related mortality, given the relative high possibility of a false negative SLND result using a small number of ALNs [9].…”

Section: Discussionmentioning

confidence: 99%

Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database

Jung

Kim

et al. 2020

Cancers

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The Z0011 trial demonstrated that axillary lymph node dissection (ALND) could be omitted in spite of 1–2 metastatic sentinel lymph nodes. This study aimed to validate the results on a population-based database. The Surveillance, Epidemiology, and End Results (SEER) database was searched for patients comparable to the Z0011 participants. The type of axillary surgery was estimated using the total number of examined axillary lymph nodes (ALNs). Breast cancer-specific mortality (BCSM) was compared between patients with ≥10 ALNs (the sentinel lymph node dissection (SLND) and ALND group, or “SLND + ALND group”) and patients with one or two ALNs (the “SLND group”). During 2010–2015, the SEER database included 7077 and 6620 patients categorized in the SLND group and the SLND + ALND group, respectively. Death was observed for 515 patients (7.3%) in the SLND group and 589 patients (8.9%) in the SLND + ALND group based on a median follow-up of 41 months. After propensity-score matching, the adjusted hazard ratio for BCSM in the SLND group (vs. the SLND + ALND group) was 1.038 (95% confidence interval: 0.798–1.350). Regardless of the SLND criteria, the outcomes were not significantly different between the two groups. This retrospective cohort study of Z0011-comparable patients revealed that ALND could be omitted based on the Z0011 strategy, even among patients with ≤2 dissected ALNs.

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Section: Discussionmentioning

confidence: 99%

Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database

Jung

Kim

et al. 2020

Cancers

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“…McBride and his colleagues investigated the value of radiotherapy in different years and found that patients in the past old times were the major benefitted population (17). Patients with one or two nodes positive who received axillary lymph node dissection or radiotherapy had a similar local recurrence rate and diseasefree survival (25,27). With the appropriate systemic treatment, the benefits of radiotherapy after mastectomy were limited for patients with low recurrence risk.…”

Section: Discussionmentioning

confidence: 99%

Post-mastectomy Radiotherapy in T1-2 Breast Cancer Patients With One to Three Lymph Node Metastases: A Propensity Score Matching Analysis

et al. 2020

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Background and Objectives: Whether post-mastectomy radiotherapy (PMRT) could improve prognosis for T1-2 breast cancer patients with one to three lymph node metastases remains controversial. The present study aimed to determine the significance of PMRT in patients with T1-2N1M0 breast cancer. Methods: Data of 45,646 patients from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed; 12,585 matched patients were divided into a PMRT group and non-radiotherapy group (no-PMRT), respectively, using the propensity score matching method. Univariate and multivariate analyses were performed to determine the prognostic factors of breast cancer, and subgroup analysis was performed according to the number of lymph node metastases. Results: With the median follow-up of 62 months, 5-year cancer-specific survival was 91.48% in the PMRT group and 91.88% in the no-PMRT group (P = 0.405). PMRT did not improve the breast cancer-specific survival (BCSS) in patients with stage T1-2N1M0 (HR = 0.99, 95% CI = 0.92-1.06, P = 0.715). In subgroup analysis, radiotherapy improved the BCSS in patients with three nodes positive, with the 5-year BCSS at 88.5% in the radiation group and 86.6% in the no-radiation group (HR = 0.78, 95% CI = 0.65-0.90, P < 0.001). In patients with two nodes positive, 5-year BCSS was 90.3% in the PMRT group and 89.5% in the no-PMRT group, with no significant difference between the two groups (HR = 0.96, 95% CI = 0.85-1.09, P = 0.552). In patients with one node positive, 5-year BCSS was higher in the no-PMRT group (92.1%) than that in the PMRT group (90.8%); radiotherapy increased the cancer-related death compared with those who did not receive it (HR = 1.21, 95% CI = 1.08-1.36, P = 0.002). Chen et al. Radiotherapy in T1-2N1M0 Breast Cancer Patients Conclusion: The benefit of PMRT in T1-2N1M0 patients was obviously different, and the recommendation of PMRT for this population should be individualized. PMRT should be considered for patients with three nodes positive, should be suggested cautiously in those with two nodes positive, and could be omitted in those with one node positive.

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“…The smaller single-center OTOASOR (Optimal Treatment Of the Axilla - Surgery Or Radiotherapy) trial, randomizing between cALND and regional nodal irradiation (RNI) in patients with SLN metastasis, reached similar results [19]. …”

Section: What Is the Best Management Of Cn0pn1(sn) Breast Cancer Patimentioning

confidence: 99%

What Is the Best Management of cN0pN1(sn) Breast Cancer Patients

et al. 2018

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Although the majority of breast cancer patients are clinically node-negative (cN0) at diagnosis, 15-20% will have a metastatic sentinel lymph node (SLN, pN1(sn)). While a less radical approach regarding axillary surgery in cN0 patients with a positive SLN biopsy is advocated, the limitations of 5 published trials on axillary management in pN1(sn) are discussed intensely in the literature and support the performance of ongoing validation and extension trials, especially considering the lack of data in the setting of mastectomy. As locoregional radiotherapy has a significant effect on both recurrence and survival, a standardization of locoregional radiotherapy in the situation of SLN biopsy alone in pN1(sn) patients has to be defined in the future, and de-escalation trials should embrace a truly multidisciplinary approach. This is also of utmost importance considering the fact that high-volume nodal disease requires an intensified adjuvant chemotherapy strategy to which patients omitting axillary dissection cannot be stratified. Finally, there is mounting evidence that the therapeutic role of extensive axillary surgery in low-volume nodal disease is negligible, and multidisciplinary and translational efforts must be undertaken to individualize treatment in order to gain a reasonable balance between necessary staging information and unnecessary treatment-related morbidity.

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Eight-year follow up result of the OTOASOR trial: The Optimal Treatment Of the Axilla – Surgery Or Radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer

Cited by 222 publications

References 25 publications

Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database

Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database

Post-mastectomy Radiotherapy in T1-2 Breast Cancer Patients With One to Three Lymph Node Metastases: A Propensity Score Matching Analysis

What Is the Best Management of cN0pN1(sn) Breast Cancer Patients

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