SLND or ALND

1Lbick, with the recent JAMA article, that showed no survival benefit of full ALND vs. SNB if women had T1 or T2 tumors (up to 5 cm) and no palpable lymph nodes, women can have a discussion with their surgeon about limiting axillary surgery to SNB.

Kira

Here is a link to the abstract: 

http://www.ncbi.nlm.nih.gov/pubmed/21304082

Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial.

Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, Leitch AM, Saha S, McCall LM, Morrow M.

John Wayne Cancer Institute at Saint John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA 90404, USA. giulianoa@jwci.org

Comment in:

* JAMA. 2011 Feb 9;305(6):606-7.

Abstract

CONTEXT: Sentinel lymph node dissection (SLND) accurately identifies nodal metastasis of early breast cancer, but it is not clear whether further nodal dissection affects survival.

OBJECTIVE: To determine the effects of complete axillary lymph node dissection (ALND) on survival of patients with sentinel lymph node (SLN) metastasis of breast cancer.

DESIGN, SETTING, AND PATIENTS: The American College of Surgeons Oncology Group Z0011 trial, a phase 3 noninferiority trial conducted at 115 sites and enrolling patients from May 1999 to December 2004. Patients were women with clinical T1-T2 invasive breast cancer, no palpable adenopathy, and 1 to 2 SLNs containing metastases identified by frozen section, touch preparation, or hematoxylin-eosin staining on permanent section. Targeted enrollment was 1900 women with final analysis after 500 deaths, but the trial closed early because mortality rate was lower than expected.

INTERVENTIONS: All patients underwent lumpectomy and tangential whole-breast irradiation. Those with SLN metastases identified by SLND were randomized to undergo ALND or no further axillary treatment. Those randomized to ALND underwent dissection of 10 or more nodes. Systemic therapy was at the discretion of the treating physician.

MAIN OUTCOME MEASURES: Overall survival was the primary end point, with a noninferiority margin of a 1-sided hazard ratio of less than 1.3 indicating that SLND alone is noninferior to ALND. Disease-free survival was a secondary end point.

RESULTS: Clinical and tumor characteristics were similar between 445 patients randomized to ALND and 446 randomized to SLND alone. However, the median number of nodes removed was 17 with ALND and 2 with SLND alone. At a median follow-up of 6.3 years (last follow-up, March 4, 2010), 5-year overall survival was 91.8% (95% confidence interval [CI], 89.1%-94.5%) with ALND and 92.5% (95% CI, 90.0%-95.1%) with SLND alone; 5-year disease-free survival was 82.2% (95% CI, 78.3%-86.3%) with ALND and 83.9% (95% CI, 80.2%-87.9%) with SLND alone. The hazard ratio for treatment-related overall survival was 0.79 (90% CI, 0.56-1.11) without adjustment and 0.87 (90% CI, 0.62-1.23) after adjusting for age and adjuvant therapy.

CONCLUSION: Among patients with limited SLN metastatic breast cancer treated with breast conservation and systemic therapy, the use of SLND alone compared with ALND did not result in inferior survival.

1Lbick I am one of those women who had level I nodes (10 on the left) removed due to tumor size and no invasion. I also have mild LE in this arm now too.

Am I upset. No. Why because although my BS didn't see anything on the MRI or feel anything in my nodes typically with a tumor my size there is an 80% chance of invasion, micro or otherwise.

Sure he could have done a SNB but we wouldn't know about micromets till when the biopsy came back. If it did come back positive then I would have to go under again… going under has serious risks too. Not sure after just doing a BMX I would be ready to go back under so soon either.

Bottom line is when the path came back negative in my nodes for mets I was happy. Actually my BS' nurse was so excited when she told me. Everyone thought for sure I was going to have micromets.  Even with the LE I still feel this was the right thing to do. I was just one of those 20% ones without mets to nodes.