Trade-offs associated with axillary lymph node dissection with breast irradiation versus breast irradiation alone in patients with a positive sentinel node in relation to the risk of non-sentinel node involvement: implications of ACOSOG Z0011.
Identifieur interne : 003039 ( Main/Exploration ); précédent : 003038; suivant : 003040Trade-offs associated with axillary lymph node dissection with breast irradiation versus breast irradiation alone in patients with a positive sentinel node in relation to the risk of non-sentinel node involvement: implications of ACOSOG Z0011.
Auteurs : Monica S. Krishnan [États-Unis] ; Abram Recht ; Jennifer R. Bellon ; Rinaa S. PungliaSource :
- Breast cancer research and treatment [ 1573-7217 ] ; 2013.
Descripteurs français
- KwdFr :
- Aisselle, Biopsie de noeud lymphatique sentinelle, Femelle, Humains, Lymphadénectomie, Noeuds lymphatiques (anatomopathologie), Prise de décision, Simulation numérique, Stade de la tumeur, Techniques d'aide à la décision, Tumeurs du sein (), Tumeurs du sein (anatomopathologie), Tumeurs du sein (mortalité), Tumeurs du sein (radiothérapie).
- MESH :
- anatomopathologie : Noeuds lymphatiques, Tumeurs du sein.
- mortalité : Tumeurs du sein.
- radiothérapie : Tumeurs du sein.
- Aisselle, Biopsie de noeud lymphatique sentinelle, Femelle, Humains, Lymphadénectomie, Prise de décision, Simulation numérique, Stade de la tumeur, Techniques d'aide à la décision, Tumeurs du sein.
English descriptors
- KwdEn :
- Axilla, Breast Neoplasms (mortality), Breast Neoplasms (pathology), Breast Neoplasms (radiotherapy), Breast Neoplasms (surgery), Computer Simulation, Decision Making, Decision Support Techniques, Female, Humans, Lymph Node Excision, Lymph Nodes (pathology), Neoplasm Staging, Sentinel Lymph Node Biopsy.
- MESH :
- mortality : Breast Neoplasms.
- pathology : Breast Neoplasms, Lymph Nodes.
- radiotherapy : Breast Neoplasms.
- surgery : Breast Neoplasms.
- Axilla, Computer Simulation, Decision Making, Decision Support Techniques, Female, Humans, Lymph Node Excision, Neoplasm Staging, Sentinel Lymph Node Biopsy.
Abstract
Recent data suggest that axillary lymph node dissection (ALND) may be unnecessary for patients with positive sentinel lymph node biopsy (SLNB) receiving whole-breast irradiation (ACOSOG Z0011). The purpose of this study was to use decision analysis with simulated patients to determine subgroups with positive SLNB who may still benefit from ALND. We performed a decision analysis simulating axillary recurrence (ALR) risk, lymphedema, and quality of life following breast-conserving surgery (BCS) with positive SLNB and either completion ALND and whole-breast radiation (ALND + BRT) or breast radiation (BRT) alone. Simulated patients were divided into two risk groups based on the likelihood of disease in non-sentinel axillary nodes after positive SLNB: those with risk 30-60 % ("high-risk") and those with risk under 30 % ("low-risk," similar to average Z0011 patients). In simulated patients aged 55, BRT alone resulted in 1 month of additional QALE in the low-risk group versus ALND + BRT, while ALND + BRT resulted in 9.7 months of additional QALE in the high-risk group versus BRT alone. Overall survival was similar at 5 years in this simulation with either treatment in both groups, but ALND + BRT was superior to BRT alone at 20 years in the high-risk group (42 vs. 38 %). In the low-risk group, BRT alone is preferable unless ALR risk with BRT is greater than 1.6 % or lymphedema risk with ALND is under 10 %. Patients eligible for Z0011 but at a higher risk of residual nodal disease following BCS and positive SLNB may benefit from ALND + BRT, rather than BRT alone.
DOI: 10.1007/s10549-013-2418-0
PubMed: 23338762
Affiliations:
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Krishnan</name><affiliation wicri:level="2"><nlm:affiliation>Harvard Radiation Oncology Program, Boston, MA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard Radiation Oncology Program, Boston, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Recht, Abram" sort="Recht, Abram" uniqKey="Recht A" first="Abram" last="Recht">Abram Recht</name></author><author><name sortKey="Bellon, Jennifer R" sort="Bellon, Jennifer R" uniqKey="Bellon J" first="Jennifer R" last="Bellon">Jennifer R. Bellon</name></author><author><name sortKey="Punglia, Rinaa S" sort="Punglia, Rinaa S" uniqKey="Punglia R" first="Rinaa S" last="Punglia">Rinaa S. Punglia</name></author></analytic><series><title level="j">Breast cancer research and treatment</title><idno type="eISSN">1573-7217</idno><imprint><date when="2013" type="published">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Axilla</term><term>Breast Neoplasms (mortality)</term><term>Breast Neoplasms (pathology)</term><term>Breast Neoplasms (radiotherapy)</term><term>Breast Neoplasms (surgery)</term><term>Computer Simulation</term><term>Decision Making</term><term>Decision Support Techniques</term><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Lymph Nodes (pathology)</term><term>Neoplasm Staging</term><term>Sentinel Lymph Node Biopsy</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Aisselle</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Femelle</term><term>Humains</term><term>Lymphadénectomie</term><term>Noeuds lymphatiques (anatomopathologie)</term><term>Prise de décision</term><term>Simulation numérique</term><term>Stade de la tumeur</term><term>Techniques d'aide à la décision</term><term>Tumeurs du sein ()</term><term>Tumeurs du sein (anatomopathologie)</term><term>Tumeurs du sein (mortalité)</term><term>Tumeurs du sein (radiothérapie)</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Noeuds lymphatiques</term><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Breast Neoplasms</term><term>Lymph Nodes</term></keywords><keywords scheme="MESH" qualifier="radiotherapy" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="radiothérapie" xml:lang="fr"><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Axilla</term><term>Computer Simulation</term><term>Decision Making</term><term>Decision Support Techniques</term><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Neoplasm Staging</term><term>Sentinel Lymph Node Biopsy</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Aisselle</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Femelle</term><term>Humains</term><term>Lymphadénectomie</term><term>Prise de décision</term><term>Simulation numérique</term><term>Stade de la tumeur</term><term>Techniques d'aide à la décision</term><term>Tumeurs du sein</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Recent data suggest that axillary lymph node dissection (ALND) may be unnecessary for patients with positive sentinel lymph node biopsy (SLNB) receiving whole-breast irradiation (ACOSOG Z0011). The purpose of this study was to use decision analysis with simulated patients to determine subgroups with positive SLNB who may still benefit from ALND. We performed a decision analysis simulating axillary recurrence (ALR) risk, lymphedema, and quality of life following breast-conserving surgery (BCS) with positive SLNB and either completion ALND and whole-breast radiation (ALND + BRT) or breast radiation (BRT) alone. Simulated patients were divided into two risk groups based on the likelihood of disease in non-sentinel axillary nodes after positive SLNB: those with risk 30-60 % ("high-risk") and those with risk under 30 % ("low-risk," similar to average Z0011 patients). In simulated patients aged 55, BRT alone resulted in 1 month of additional QALE in the low-risk group versus ALND + BRT, while ALND + BRT resulted in 9.7 months of additional QALE in the high-risk group versus BRT alone. Overall survival was similar at 5 years in this simulation with either treatment in both groups, but ALND + BRT was superior to BRT alone at 20 years in the high-risk group (42 vs. 38 %). In the low-risk group, BRT alone is preferable unless ALR risk with BRT is greater than 1.6 % or lymphedema risk with ALND is under 10 %. Patients eligible for Z0011 but at a higher risk of residual nodal disease following BCS and positive SLNB may benefit from ALND + BRT, rather than BRT alone.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Massachusetts</li></region></list><tree><noCountry><name sortKey="Bellon, Jennifer R" sort="Bellon, Jennifer R" uniqKey="Bellon J" first="Jennifer R" last="Bellon">Jennifer R. Bellon</name><name sortKey="Punglia, Rinaa S" sort="Punglia, Rinaa S" uniqKey="Punglia R" first="Rinaa S" last="Punglia">Rinaa S. Punglia</name><name sortKey="Recht, Abram" sort="Recht, Abram" uniqKey="Recht A" first="Abram" last="Recht">Abram Recht</name></noCountry><country name="États-Unis"><region name="Massachusetts"><name sortKey="Krishnan, Monica S" sort="Krishnan, Monica S" uniqKey="Krishnan M" first="Monica S" last="Krishnan">Monica S. Krishnan</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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