A Randomized Trial Comparing Axillary Dissection to No Axillary Dissection in Older Patients With T1N0 Breast Cancer
Identifieur interne : 008059 ( Main/Exploration ); précédent : 008058; suivant : 008060A Randomized Trial Comparing Axillary Dissection to No Axillary Dissection in Older Patients With T1N0 Breast Cancer
Auteurs : Gabriele Martelli ; Patrizia Boracchi ; Michaela De Palo ; Silvana Pilotti ; Saro Oriana ; Roberto Zucali ; Maria Grazia Daidone ; Giuseppe De PaloSource :
- Annals of Surgery [ 0003-4932 ] ; 2005.
Abstract
Axillary dissection, an invasive procedure that may adversely affect quality of life, used to obtain prognostic information in breast cancer, is being supplanted by sentinel node biopsy. In older women with early breast cancer and no palpable axillary nodes, it may be safe to give no axillary treatment. We addressed this issue in a randomized trial comparing axillary dissection with no axillary dissection in older patients with T1N0 breast cancer.
From 1996 to 2000, 219 women, 65 to 80 years of age, with early breast cancer and clinically negative axillary nodes were randomized to conservative breast surgery with or without axillary dissection. Tamoxifen was prescribed to all patients for 5 years. The primary endpoints were axillary events in the no axillary dissection arm, comparison of overall mortality (by log rank test), breast cancer mortality, and breast events (by Gray test).
Considering a follow-up of 60 months, there were no significant differences in overall or breast cancer mortality, or crude cumulative incidence of breast events, between the 2 groups. Only 2 patients in the no axillary dissection arm (8 and 40 months after surgery) developed overt axillary involvement during follow-up.
Older patients with T1N0 breast cancer can be treated by conservative breast surgery and no axillary dissection without adversely affecting breast cancer mortality or overall survival. The very low cumulative incidence of axillary events suggests that even sentinel node biopsy is unnecessary in these patients. Axillary dissection should be reserved for the small proportion of patients who later develop overt axillary disease.
Url:
DOI: 10.1097/01.sla.0000167759.15670.14
PubMed: 15973094
PubMed Central: 1357697
Affiliations:
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Le document en format XML
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<front><div type="abstract" xml:lang="en"><sec><title>Summary Background Data:</title>
<p>Axillary dissection, an invasive procedure that may adversely affect quality of life, used to obtain prognostic information in breast cancer, is being supplanted by sentinel node biopsy. In older women with early breast cancer and no palpable axillary nodes, it may be safe to give no axillary treatment. We addressed this issue in a randomized trial comparing axillary dissection with no axillary dissection in older patients with T1N0 breast cancer.</p>
</sec>
<sec><title>Methods:</title>
<p>From 1996 to 2000, 219 women, 65 to 80 years of age, with early breast cancer and clinically negative axillary nodes were randomized to conservative breast surgery with or without axillary dissection. Tamoxifen was prescribed to all patients for 5 years. The primary endpoints were axillary events in the no axillary dissection arm, comparison of overall mortality (by log rank test), breast cancer mortality, and breast events (by Gray test).</p>
</sec>
<sec><title>Results:</title>
<p>Considering a follow-up of 60 months, there were no significant differences in overall or breast cancer mortality, or crude cumulative incidence of breast events, between the 2 groups. Only 2 patients in the no axillary dissection arm (8 and 40 months after surgery) developed overt axillary involvement during follow-up.</p>
</sec>
<sec><title>Conclusions:</title>
<p>Older patients with T1N0 breast cancer can be treated by conservative breast surgery and no axillary dissection without adversely affecting breast cancer mortality or overall survival. The very low cumulative incidence of axillary events suggests that even sentinel node biopsy is unnecessary in these patients. Axillary dissection should be reserved for the small proportion of patients who later develop overt axillary disease.</p>
</sec>
</div>
</front>
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<name sortKey="Daidone, Maria Grazia" sort="Daidone, Maria Grazia" uniqKey="Daidone M" first="Maria Grazia" last="Daidone">Maria Grazia Daidone</name>
<name sortKey="De Palo, Giuseppe" sort="De Palo, Giuseppe" uniqKey="De Palo G" first="Giuseppe" last="De Palo">Giuseppe De Palo</name>
<name sortKey="De Palo, Michaela" sort="De Palo, Michaela" uniqKey="De Palo M" first="Michaela" last="De Palo">Michaela De Palo</name>
<name sortKey="Martelli, Gabriele" sort="Martelli, Gabriele" uniqKey="Martelli G" first="Gabriele" last="Martelli">Gabriele Martelli</name>
<name sortKey="Oriana, Saro" sort="Oriana, Saro" uniqKey="Oriana S" first="Saro" last="Oriana">Saro Oriana</name>
<name sortKey="Pilotti, Silvana" sort="Pilotti, Silvana" uniqKey="Pilotti S" first="Silvana" last="Pilotti">Silvana Pilotti</name>
<name sortKey="Zucali, Roberto" sort="Zucali, Roberto" uniqKey="Zucali R" first="Roberto" last="Zucali">Roberto Zucali</name>
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