POSNOC: A Randomised Trial Looking at Axillary Treatment in Women with One or Two Sentinel Nodes with Macrometastases

Goyal, Amit; Dodwell, David

doi:10.1016/j.clon.2015.07.005

Cited by 133 publications

(78 citation statements)

References 16 publications

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“…The ongoing POSNOC trial may finally answer the question whether no further axillary treatment, AD, or ART should be the treatment of choice for SLN-positive breast cancer patients [33]. However, this study is not expected to complete accrual before 2018.…”

Section: Discussionmentioning

confidence: 99%

Lymph Node Radiotherapy Instead of Extended Axillary Surgery - the New Standard

Niehoff¹,

Hey-Koch²

2018

Breast Care

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Breast cancer treatment has undergone major changes in the last 20 years. Specifically, the role of axillary lymph node dissection has changed from radical axillary dissection with excision of a high number of lymph nodes to sentinel lymph node biopsy (SLNB). This paradigm shift is associated with a controversial debate regarding the significance of axillary staging, the need for surgery, and the role of radiotherapy. Looking ahead, lymph node staging and axillary treatment might shift from SLNB and/or axillary dissection to ultrasound-guided needle biopsy and irradiation of regional lymph nodes in order to reduce treatment-related sequelae in early-stage breast cancer.

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Section: Discussionmentioning

confidence: 99%

Lymph Node Radiotherapy Instead of Extended Axillary Surgery - the New Standard

Niehoff¹,

Hey-Koch²

2018

Breast Care

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“…The role of further axillary treatment in women with 2 or less positive nodes at sentinel node biopsy was challenged by ACOSOG Z0011 [31] and is being studied in the confirmatory POSNOC study [32]. Therefore we are now questioning the role of removing the sentinel nodes, and efforts are underway to stage the axilla without surgery [33].…”

Section: Non-operative Axillary Stagingmentioning

confidence: 99%

New Technologies for Sentinel Lymph Node Detection

Goyal¹

2018

Breast Care

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The ‘standard of care' method for sentinel node mapping is the combination technique using radioisotope and blue dye although some centres use radioisotope or blue dye alone. Radioisotope usage requires licensing, has regulatory issues around handling and disposal of waste, and logistically may be unavailable or difficult to implement in some centres or less developed country. This has led to the development of alternative methods such as superparamagnetic iron oxide (SPIO), fluorescence techniques using indocyanine green (ICG) or fluorescein, computed tomography lymphography, and contrast-enhanced ultrasound scan (CEUS) using microbubbles. The newer techniques will potentially enable a more widespread adoption of this procedure; however, a common barrier for these techniques is the lack of standardisation and no randomised trials to evaluate their effectiveness against the current standard of care. Furthermore, many of these techniques are more costly and may become redundant in node-negative patients with small tumours if ongoing trials show that sentinel node biopsy offers no additional benefit to grey-scale axillary ultrasound. This review discusses the new techniques for sentinel node mapping that have emerged including their pros and cons.

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“…Despite their different designs and target populations, these trials (POSNOC [29], INSEMA [30], SENOMAC [31], and SINODAR ONE [32]) should be able to answer whether omission of cALND is oncologically safe even in larger tumors (T3, SENOMAC), in the presence of more than 2 SLN metastases (INSEMA), in mastectomy patients (SENOMAC, POSNOC, SINODAR ONE), and in the case of extranodal extension. Significant heterogeneity in proposed RT may call for a pooled analysis in a larger setting in order to define the impact of unintentional and intentional axillary irradiation.…”

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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POSNOC: A Randomised Trial Looking at Axillary Treatment in Women with One or Two Sentinel Nodes with Macrometastases

Cited by 133 publications

References 16 publications

Lymph Node Radiotherapy Instead of Extended Axillary Surgery - the New Standard

Lymph Node Radiotherapy Instead of Extended Axillary Surgery - the New Standard

New Technologies for Sentinel Lymph Node Detection

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

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