Advertisement

Annals of Surgical Oncology

, Volume 24, Issue 3, pp 652–659 | Cite as

Outcomes of Sentinel Lymph Node-Positive Breast Cancer Patients Treated with Mastectomy Without Axillary Therapy

  • Elizabeth FitzSullivan
  • Roland L. Bassett
  • Henry M. Kuerer
  • Elizabeth A. Mittendorf
  • Min Yi
  • Kelly K. Hunt
  • Gildy V. Babiera
  • Abigail S. Caudle
  • Dalliah M. Black
  • Isabelle Bedrosian
  • Chantal Reyna
  • Mediget Teshome
  • Funda Meric-Bernstam
  • Rosa Hwang
Breast Oncology

Abstract

Purpose

Early-stage breast cancer patients with minimal axillary disease identified by sentinel lymph node dissection (SLND) have low regional recurrence rates when treated with breast-conserving surgery and radiation therapy (XRT) and many avoid a completion axillary lymph node dissection (CLND). As the incidence of total mastectomy (TM) has increased, it has become important to characterize which TM patients with a positive SLN may not benefit from further axillary treatment.

Methods

An institutional database was utilized to identify patients treated with a TM for invasive breast cancer and who had a positive SLN from 1994 to 2010. Clinicopathologic factors were analyzed. Regional recurrence rate, recurrence-free survival (RFS), and overall survival (OS) were determined.

Results

A total of 525 patients with invasive breast cancer and a positive SLN were treated with TM, including 58 patients who did not have CLND or XRT and 12 patients who did not have CLND but did receive XRT. Median follow-up was 66 months. The incidence of regional recurrence was not significantly different for patients who received no further axillary treatment compared to those who underwent CLND without XRT or those treated with XRT without CLND (10 years rate: 3.8 vs. 1.6 and 0 % respectively). RFS and OS were not significantly different among patients who received no further axillary treatment compared to those who underwent CLND, XRT, or both.

Conclusions

In select patients with early-stage breast cancer treated with mastectomy with a positive SLN, CLND may be avoided without adversely affecting recurrence or survival.

Keywords

Overall Survival Regional Recurrence Total Mastectomy Sentinel Lymph Node Dissection Memorial Sloan Kettering Cancer Center 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The University of Texas MD Anderson Cancer Center is supported in part by the National Institutes of Health through Cancer Center Support Grant CA016672.

Disclosure

The authors indicate no potential conflict of interest.

Supplementary material

10434_2016_5605_MOESM1_ESM.mp3 (2.7 mb)
Supplementary material 1 (MP3 2743 KB)

References

  1. 1.
    Peintinger F, Reitsamer R, Stranzl H, Ralph G. Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients. Br J Cancer. 2003;89(4):648-52.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Blanchard DK, Donohue JH, Reynolds C, Grant CS. Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer. Arch Surg. 2003;138(5):482-7; discussion 487-8.CrossRefPubMedGoogle Scholar
  3. 3.
    Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426-32; discussion 432-3.PubMedGoogle Scholar
  4. 4.
    Baruch AC, Wang H, Staerkel GA, Evans DB, Hwang RF, Krishnamurthy S. Immunocytochemical study of the expression of mesothelin in fine-needle aspiration biopsy specimens of pancreatic adenocarcinoma. Diagn Cytopathol. 2007;35(3):143-7.CrossRefPubMedGoogle Scholar
  5. 5.
    Cyr A, Gao F, Gillanders WE, Aft RL, Eberlein TJ, Margenthaler JA. Disease recurrence in sentinel node-positive breast cancer patients forgoing axillary lymph node dissection. Ann Surg Oncol. 2012;19(10):3185-91.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bilimoria KY, Bentrem DJ, Hansen NM, et al. Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol. 2009;27(18):2946-53.CrossRefPubMedGoogle Scholar
  7. 7.
    Naik AM, Fey J, Gemignani M, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg. 2004;240(3):462-8; discussion 468-71.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Jagsi R, Chadha M, Moni J, et al. Radiation field design in the ACOSOG Z0011 (Alliance) Trial. J Clin Oncol. 2014;32(32):3600-6.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471-4.CrossRefPubMedGoogle Scholar
  10. 10.
    Mittendorf EA, Hunt KK, Boughey JC, et al. Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg. 2012;255(1):109-15.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297-305.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Milgrom S, Cody H, Tan L, et al. Characteristics and outcomes of sentinel node-positive breast cancer patients after total mastectomy without axillary-specific treatment. Ann Surg Oncol. 2012;19(12):3762-70.CrossRefPubMedGoogle Scholar
  13. 13.
    Snow R, Reyna C, Johns C, et al. Outcomes with and without axillary node dissection for node-positive lumpectomy and mastectomy patients. Am J Surg. 2015;210(4):685–93.CrossRefPubMedGoogle Scholar
  14. 14.
    Yao K, Liederbach E, Pesce C, Wang CH, Winchester DJ. Impact of the American College of Surgeons Oncology Group Z0011 Randomized Trial on the number of axillary nodes removed for patients with early-stage breast cancer. J Am Coll Surg. 2015;221(1):71-81.CrossRefPubMedGoogle Scholar
  15. 15.
    Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-61.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Garg AK, Buchholz TA. Influence of neoadjuvant chemotherapy on radiotherapy for breast cancer. Ann Surg Oncol. 2015;22(5):1434-40.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Elizabeth FitzSullivan
    • 1
  • Roland L. Bassett
    • 2
  • Henry M. Kuerer
    • 1
  • Elizabeth A. Mittendorf
    • 1
  • Min Yi
    • 1
  • Kelly K. Hunt
    • 1
  • Gildy V. Babiera
    • 1
  • Abigail S. Caudle
    • 1
  • Dalliah M. Black
    • 1
  • Isabelle Bedrosian
    • 1
  • Chantal Reyna
    • 1
  • Mediget Teshome
    • 1
  • Funda Meric-Bernstam
    • 1
  • Rosa Hwang
    • 1
  1. 1.Department of Breast Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations