The
American College of Surgeons sentinel node trial: Part one: Node-positive
patients
Interview
with Neil Love, MD from Breast Cancer Update for Surgeons,
Program 2 2000
Play
Audio Below:
In
Z11, the second part of the sentinel node trial, which is a randomized
trial for women who are node positive, the problem is many surgeons
believe that axillary dissection is therapeutic and are reluctant
to not perform axillary dissection on patients with a positive sentinel
node. And as you know, the therapeutic value of axillary dissection
is not so clear. There have been a number of randomized studies
that have failed to show that axillary dissection imparts an improved
survival. So I think for an operation that’s been used for
a 100 years it’s time that we answer the question and find
out if axillary dissection affects survival.
There
are many reasons why sentinel node alone may replace axillary dissection.
In node negative patients I think its clear that sentinel node accurately
stages patients and to remove normal lymph nodes is not likely to
be beneficial. So most people don’t argue with not completing
an axillary dissection in sentinel node negative patients. In node
positive women the sentinel node may be enough because a large part
of the time it’s the only involved node. Veronesi’s series
was 50%, Albertini’s 60% and in our hands its almost 70%. You’ll
remove the sentinel node, it’s positive, complete the axillary
dissection, there’ll be no other lymph nodes with metastasis.
In addition, virtually all node positive women in this country get
adjuvant systemic therapy – usually cytotoxic chemotherapy.
That may take care of any residual problem in the axilla. And, patients
are getting opposing tangential fields and we know that that’s
partial axillary radiation therapy. You get at least level 1 1/2
when you do opposing tangential fields, so that may destroy any
residual lymph node metastases. If you look at studies where patients
were treated with lumpectomy alone with radiation and no axillary
dissection, the recurrence rate in the axilla is extraordinarily
low. So I think it’s a very important, very justifiable and
ethical trial.
Is
routine intraoperative frozen-section examination of sentinel lymph
nodes in breast cancer worthwhile Weiser, M. R.; Montgomery,
L. L.; Susnik, B.; Tan, L. K.; Borgen, P. I., and Cody, H. S.? Annals
of Surgical Oncology. 7(9):651-655, 2000 Oct. In progress
Micrometastatic
nodal disease in breast cancer - The dilemma continues. Rose,
M. D. and Giuliano, A. E. (Reprint available from: Giuliano
AE St Johns Hlth Ctr, John Wayne Canc Inst 2200 Santa Monica Blvd
Santa Monica, CA 90404 USA). Journal of Surgical Oncology. 74(2):87-89,
2000 Jun. No abstract
Variation
in axillary node dissection influences the degree of nodal involvement
in breast cancer patients.
Saha, S.; Farrar, W. B.; Young, D. C.; Ferrara, J. J., and Burak,
W. E.. Journal of Surgical Oncology. 73(3):134-137, 2000 Mar.
A
multicenter validation study of sentinel lymph node biopsy by the
Japanese Breast Cancer Society.
Noguchi, M.; Motomura, K.; Imoto, S.; Miyauchi, M.; Sato, K.; Iwata,
H.; Ohta, M.; Kurosumi,
M., and Tsugawa, K. (Reprint available from: Noguchi M Kanazawa
Univ Hosp, Operat Ctr Takara Machi 13-1 Kanazawa Ishikawa 9208641
Japan).. Breast Cancer Research & Treatment. 63(1):31-40, 2000
Sep. In process
Sentinel-node
biopsy sampling in breast cancer. Nieweg, O. E.; Tanis, P. J.; Olmos, R. A. V.; Rutgers, E. J.
T., and Kroon, B. B. R. (Reprint available from: Nieweg OE Netherlands
Canc Inst, Antoni Van Leeuwenhoek Hosp, Dept Surg Plesmanlaan 121
NL-1066 CX Amsterdam Netherlands).. Lancet. 356(9243): 1770, 2000
Nov 18. In process
Increased
false negative sentinel node biopsy rates after preoperative chemotherapy
for invasive breast carcinoma Nason,
K. S.; Anderson, B. O.; Byrd, D. R.; Dunnwald, L. K.; Eary, J. F.;
Mankoff, D. A.; Livingston, R.; Schmidt, R. A.; Jewell, K. D.; Yeung,
R. S., and Moe, R. E.. Cancer. 89(11):2187-2194, 2000 Dec 1. In
process
Pathologic
analysis of sentinel lymph nodes in breast carcinoma. Liberman,
L. (Reprint available from: Liberman L Mem Sloan Kettering Canc
Ctr, Dept Radiol, Breast Imaging Sect 1275 York Ave New York, NY
10021 USA). Cancer. 88(5):971-977, 2000 Mar 1. No abstract
Long-term
morbidity following axillary dissection in breast cancer patients
- clinical assessment, significance for life quality and the impact
of demographic, oncologic and therapeutic factors. Kuehn,
T.; Klauss, W.; Darsow, M.; Regele, S.; Flock, F.; Maiterth, C.;
Dahlbender, R.; Wendt, I., and Kreienberg, R. Breast Cancer Research
& Treatment. 64(3):275-286, 2000 Dec.
Sentinel
lymph node biopsy: Is it indicated in patients with high-risk ductal
carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Klauber-DeMore, N.; Tan, L. K.; Liberman, L.; Kaptain, S.; Fey,
J.; Borgen, P.; Heerdt, A.; Montgomery, L.; Paglia, M.; Petrek,
J. A.; Cody, H. S., and Van Zee, K. J. Annals of Surgical Oncology.
7(9):636-642, 2000 Oct. In process
Pilot
study on sentinel node biopsy in breast cancer - Commentary Greene, F. L. (Reprint available from: Greene FL Carolinas Med
Ctr, Dept Gen Surg Charlotte, NC 28203 USA).. Journal of Surgical
Oncology. 73(3):133, 2000 Mar.
Impact
of sentinel lymph node mapping on relative charge in patients with
early-stage breast cancer. Gemignani, M. L.; Cody, H. S.; Fey, J. V.; Tran, K. N.; Venkatraman,
E., and Borgen, P. I. Annals of Surgical Oncology. 7(8):575-580,
2000 Sep. In process
Does
sentinel lymphadenectomy improve staging and alter therapy in elderly
women with breast cancer? DiFronzo, L. A.; Hansen, N. M.; Stern, S. L.; Brennan, M. B.,
and Giuliano, A. E. Annals of Surgical Oncology. 7(6):406-410, 2000
Jul. In process
A
high number of tumor free axillary lymph nodes from patients with
lymph node negative breast is associated with poor outcome. Cody, H. S. and Van Zee, K. J. (Reprint available from: Cody
HS Mem Sloan Kettering Canc Ctr, Dept Radiat Oncol 1275 York Ave
New York, NY 10021 USA).. Cancer. 89(1):218, 2000 Jul 1. No abstract
Challenging
the myth of exercise-induced lymphedema following breast cancer:
A series of case reports — Commentary.
(Reprint available from: Cady B Brown Univ, Women & Infants
Hosp, Breast Hlth Ctr Providence, RI 02908 USA).. Journal of Surgical
Oncology. 74(2):98-99, 2000 Jun. No abstract
Should
irradiation replace dissection for patients with breast cancer with
clinically negative axillary lymph nodes? Recht, A. (Reprint available from: Recht A Beth Israel Deaconess
Med Ctr, Dept Radiat Oncol East Campus,Finard Bldg B25,330 Brookline
Ave Boston, MA 02215 USA). Journal of Surgical Oncology. 72(4):184-192,
1999 Dec. No abstract
Lymphedema:
Current issues in research and management. Petrek,
J. A.; Pressman, P. I., and Smith, R. A. Ca: a Cancer Journal for
Clinicians. 50(5):292-307, 2000 Sep-Oct.
