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Judy C Boughey - One of the best experts on this subject based on the ideXlab platform.

  • changes in management strategy and impact of neoadjuvant therapy on extent of Surgery in invasive lobular carcinoma of the breast analysis of the national cancer database ncdb
    Annals of Surgical Oncology, 2021
    Co-Authors: Rita A Mukhtar, Tanya L Hoskin, Elizabeth B Habermann, Courtney N Day, Judy C Boughey
    Abstract:

    Given reports of low response rates to neoadjuvant chemotherapy (NAC) in invasive lobular carcinoma (ILC), we evaluated whether use of alternative strategies such as neoadjuvant endocrine therapy (NET) is increasing. Additionally, we investigated whether NET is associated with more breast conservation Surgery (BCS) and less extensive Axillary Surgery in those with ILC. We queried the NCDB from 2010 to 2016 and identified all women with stage I–III hormone receptor positive, human epidermal growth factor receptor-2 negative (HR+/HER2−) ILC who underwent Surgery. We used Cochrane–Armitage tests to evaluate trends in utilization of the following treatment strategies: NAC, short-course NET, long-course NET, and primary Surgery. We compared rates of BCS and extent of Axillary Surgery stratified by clinical stage and tumor receptor subtype for each treatment strategy. Among 69,312 cases of HR+/HER2− ILC, NAC use decreased slightly (from 4.7 to 4.2%, p = 0.007), while there was a small but significant increase in long-course NET (from 1.6 to 2.7%, p < 0.001). Long-course NET was significantly associated with increased BCS in patients with cT2–cT4 disease and less extensive Axillary Surgery in clinically node positive patients with HR+/HER2− tumors. Primary Surgery remains the most common treatment strategy in patients with ILC. However, NAC use decreased slightly over the study period, while the use of long-course NET had a small increase and was associated with more BCS and less extensive Axillary Surgery.

  • breast cancer related lymphedema risk is related to multidisciplinary treatment and not Surgery alone results from a large cohort study
    Annals of Surgical Oncology, 2017
    Co-Authors: Toan T Nguyen, Elizabeth B Habermann, Tanya L Hoskin, Andrea L Cheville, Judy C Boughey
    Abstract:

    Breast cancer-related lymphedema (BCRL) is a significant complication for women undergoing treatment. We assessed BCRL incidence and risk factors in a large population-based cohort. We utilized the Olmsted County Rochester Epidemiology Project Breast Cancer Cohort from 1990–2010 and ascertained BCRL and risk factors. The cumulative incidence estimator was used to estimate the rate of BCRL; competing risks regression was used for multivariable analysis. A total of 1794 patients with stage 0–3 breast cancer with a median of 10 years follow-up were included. The cumulative incidence of BCRL diagnosis within 5 years was 9.1% [95% confidence interval (CI) 7.8–10.5%]. No BCRL events occurred among patients without Axillary Surgery. In the Axillary Surgery subset (n = 1512), the 5-year incidence of BCRL was 5.3% in sentinel lymph node (SLN) Surgery and 15.9% in Axillary dissection (ALND) patients (p 25% at 5 years) all involved ALND with nodal RT and/or anthracycline/cytoxan + taxane chemotherapy. In multivariable analysis of patients with any Axillary Surgery factors significantly associated with BCRL were ALND, chemotherapy, radiation, and obesity. BCRL is a sequelae of multimodal breast cancer treatment and risk is multifactorial. BCRL rates are higher in patients receiving chemotherapy, radiation, ALND, more advanced disease stage, and higher body mass index.

  • is Axillary Surgery beneficial for patients with adenoid cystic carcinoma of the breast
    Journal of Surgical Oncology, 2017
    Co-Authors: Jessemae L Welsh, Judy C Boughey, Tanya L Hoskin, Michael G Keeney, Katrina N Glazebrook, Sejal M Shah, Tina J Hieken
    Abstract:

    Background and objectives Adenoid cystic carcinoma (ACC) is a rare, typically triple-negative, breast cancer reported to have a favorable prognosis and low rate of nodal metastasis. No consensus guidelines exist for Axillary staging and treatment. Methods We identified all patients with ACC evaluated at our institution from January 1994 to August 2016. Patient, tumor, and treatment variables were abstracted and analyzed. Results We identified 20 pure ACCs (0.13% of all invasive breast cancers) with size range 0.2-4.8 cm, in 19 women, median age 59 years. Preoperative Axillary ultrasound was normal in 10/13 women and suspicious in 3/13 who had a subsequent negative lymph node fine needle aspiration (FNA). Fifteen patients (75%) had sentinel lymph node Surgery and were pathologically node-negative, while the remaining five had no Axillary Surgery. With 3.6 years median follow-up (range 0.2-38.6 years), three patients experienced an in-breast recurrence at 2, 16, and 17 years, respectively, while none recurred in regional nodes. Conclusions We observed no cases of nodal metastasis in 20 consecutive cases of ACC of the breast. Preoperative Axillary ultrasound with FNA of suspicious nodes accurately predicted pathologic nodal stage. These data suggest Axillary Surgery might be omitted safely in patients with pure ACC and a clinically negative axilla.

  • the timing of breast and Axillary Surgery after neoadjuvant chemotherapy for breast cancer
    Chinese clinical oncology, 2016
    Co-Authors: Zahraa Alhilli, Judy C Boughey
    Abstract:

    Neoadjuvant chemotherapy (NAC) has traditionally been used in locally advanced and inflammatory breast cancer, allowing for a reduction in disease volume and therefore optimizing surgical resection of disease in the breast. NAC impacts both the tumor in the breast and the lymph nodes and may allow for the option of breast-conserving Surgery and avoiding an Axillary dissection. The aim of this review is to discuss the considerations and timing of surgical treatment of the breast and the axilla following NAC in patients with breast cancer.

  • preoperative Axillary imaging with percutaneous lymph node biopsy is valuable in the contemporary management of patients with breast cancer
    Surgery, 2013
    Co-Authors: Tina J Hieken, Judy C Boughey, Sejal M Shah, Katie N Jones, Brent C Trull, Carol Reynolds, Katrina Nesta Glazebrook
    Abstract:

    Background ACOSOG Z11 and other studies showing little benefit to Axillary dissection (ALND) for early-stage breast cancers with limited nodal disease have led to questioning the value of preoperative Axillary imaging ± ultrasound-guided needle biopsy (USNB). Data are lacking on the value of this approach in identifying cases that fall outside Z11 guidelines. Methods We studied 988 consecutive patients with invasive breast cancers who underwent operation including Axillary Surgery in 2010–2011. Results Preoperative Axillary ultrasonography (AUS) was performed in 92% and breast/Axillary magnetic resonance imaging (MRI) in 51%; 82 (33.5%) of 245 patients with suspicious lymph nodes (LN) were USNB-positive. Regarding nodal status, AUS, MRI, and USNB had negative and positive predictive values of 78%, 76%, 70% and 54%, 58%, 100%, respectively. AUS/MRI visualization of one versus multiple abnormal LNs visualized predicted >2LN+ on final pathology (13.5%/15.1% % vs 30.8%/32.6%, P 2LN+, P = .001. Conclusion In our contemporary series, preoperative AUS±USNB streamlined surgical care for 29% of node-positive patients. Two-thirds of T1/T2 USNB-LN+ patients with multiple AUS-suspicious LNs had >2LN+, suggesting they should undergo ALND without SLNB. AUS±USNB helps identify node-positive breast cancer patients who fall outside Z11 guidelines.

Barbara L. Smith - One of the best experts on this subject based on the ideXlab platform.

  • Quantifying the Impact of Axillary Surgery and Nodal Irradiation on Breast Cancer-Related Lymphedema and Local Tumor Control: Long-Term Results From a Prospective Screening Trial.
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2020
    Co-Authors: George E. Naoum, Cheryl L Brunelle, Laura Salama, Sacha A. Roberts, Amy Shui, Kayla M. Daniell, Tessa C. Gillespie, Loryn K. Bucci, Barbara L. Smith
    Abstract:

    PURPOSETo independently evaluate the impact of Axillary Surgery type and regional lymph node radiation (RLNR) on breast cancer–related lymphedema (BCRL) rates in patients with breast cancer.PATIENT...

  • sentinel lymph node biopsy at the time of mastectomy does not increase the risk of lymphedema implications for prophylactic Surgery
    Breast Cancer Research and Treatment, 2012
    Co-Authors: Cynthia L Miller, Michelle C Specht, Melissa N Skolny, Lauren S Jammallo, Nora Horick, Jean Otoole, Suzanne B Coopey, Kevin S Hughes, Michele A Gadd, Barbara L. Smith
    Abstract:

    Women diagnosed with or at high risk for breast cancer increasingly choose prophylactic mastectomy. It is unknown if adding sentinel lymph node biopsy (SLNB) to prophylactic mastectomy increases the risk of lymphedema. We sought to determine the risk of lymphedema after mastectomy with and without nodal evaluation. 117 patients who underwent bilateral mastectomy were prospectively screened for lymphedema. Perometer arm measurements were used to calculate weight-adjusted arm volume change at each follow-up. Of 234 mastectomies performed, 15.8 % (37/234) had no Axillary Surgery, 63.7 % (149/234) had SLNB, and 20.5 % (48/234) had Axillary lymph node dissection (ALND). 88.0 % (103/117) of patients completed the LEFT-BC questionnaire evaluating symptoms associated with lymphedema. Multivariate analysis was used to assess clinical characteristics associated with increased weight-adjusted arm volume and patient-reported lymphedema symptoms. SLNB at the time of mastectomy did not result in an increased mean weight-adjusted arm volume compared to mastectomy without Axillary Surgery (p = 0.76). Mastectomy with ALND was associated with a significantly greater mean weight-adjusted arm volume change compared to mastectomy with SLNB (p < 0.0001) and without Axillary Surgery (p = 0.0028). Patients who underwent mastectomy with ALND more commonly reported symptoms associated with lymphedema compared to those with SLNB or no Axillary Surgery (p < 0.0001). Patients who underwent mastectomy with SLNB or no Axillary Surgery reported similar lymphedema symptoms. Addition of SLNB to mastectomy is not associated with a significant increase in measured or self-reported lymphedema rates. Therefore, SLNB may be performed at the time of prophylactic mastectomy without an increased risk of lymphedema.

  • pl3 1 advances in Axillary Surgery sentinel nodes and beyond
    Cancer Research, 2011
    Co-Authors: Barbara L. Smith
    Abstract:

    Axillary node status is one of the strongest prognostic factors in breast cancer patients. The presence of tumor in Axillary nodes, and number of positive nodes, predicts risk of metastatic disease and long term survival. In the past, Axillary dissection provided both accurate evaluation of nodal status and excellent local control. However, complications of Axillary dissection, including lymphedema, pain, and impaired arm function, have led to keen interest in alternatives to Axillary dissection for local control and assessment of prognosis. Sentinel node biopsy provides a low-morbidity alternative to Axillary dissection for patients with clinically negative nodes. It was recognized that breast lymphatics converge in the axilla, delivering fluid, travelling tumor cells and dye particles to a small number of “sentinel” nodes. Sentinel node biopsy techniques take advantage of this lymphatic anatomy using dye injection intraoperatively to permit identification and removal of only the most important Axillary nodes - those most likely to contain metastases. A negative sentinel node provides accurate staging and reliably predicts a low Axillary recurrence rate, eliminating the need for dissection. Sentinel node mapping also allows study of the relationship between the size of a nodal metastasis and impact on prognosis. Sentinel node mapping techniques, morbidity, and data on the reliability of sentinel node biopsy will be reviewed. 40–50% of patients with a positive sentinel node will have additional positive Axillary nodes, indicating a need for additional Axillary treatment for local control. Completion Axillary dissection was initially used for local control and prognostic assessment in patients with a positive sentinel node. Recently, the ACOSOG Z0011 trial showed that patients with 1 or 2 positive sentinel nodes who receive standard whole breast irradiation without further Axillary Surgery have equivalent local control as patients having completion Axillary dissection. Axillary recurrence rates in the Z0011 trial were Management of the axilla will evolve further as options for assessment of tumor and host factors increase. Gene expression profiling may prove more important than primary tumor size and node status for predicting prognosis and guiding therapy - an approach already used in estrogen receptor positive tumors. Future options for incorporating Axillary node status with tumor and host factors in breast cancer management will be considered. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PL3-1.

  • tangential radiotherapy without Axillary Surgery in early stage breast cancer results of a prospective trial
    International Journal of Radiation Oncology Biology Physics, 2005
    Co-Authors: Julia S Wong, Barbara L. Smith, Alphonse G Taghian, Jennifer R Bellon, Aparna Keshaviah, Eric P Winer, Barbara Silver, Jay R Harris
    Abstract:

    Purpose To determine the risk of regional-nodal recurrence in patients with early-stage, invasive breast cancer, with clinically negative Axillary nodes, who were treated with breast-conserving Surgery, “high tangential” breast radiotherapy, and hormonal therapy, without Axillary Surgery or the use of a separate nodal radiation field. Methods and Materials Between September 1998 and November 2003, 74 patients who were ≥55 years of age with Stage I-II clinically node-negative, hormone-receptor–positive breast cancer underwent tumor excision to negative margins without Axillary Surgery as a part of a multi-institutional prospective study. Postoperatively, all underwent high-tangential, whole-breast radiotherapy with a boost to the tumor bed, followed by 5 years of hormonal therapy. Results For the 74 patients enrolled, the median age was 74.5 years, and the median pathologic tumor size was 1.2 cm. Lymphatic vessel invasion was present in 5 patients (7%). At a median follow-up of 52 months, no regional-nodal failures or ipsilateral breast recurrences had been identified (95% confidence interval, 0–4%). Eight patients died, one of metastatic disease and seven of other causes. Conclusion In this select group of mainly older patients with early-stage hormone-responsive breast cancer and clinically negative Axillary nodes, treatment with high-tangential breast radiotherapy and hormonal therapy, without Axillary Surgery, yielded a low regional recurrence rate. Such patients might be spared more extensive Axillary treatment (Axillary Surgery, including sentinel node biopsy, or a separate nodal radiation field), with its associated time, expense, and morbidity.

Tanya L Hoskin - One of the best experts on this subject based on the ideXlab platform.

  • changes in management strategy and impact of neoadjuvant therapy on extent of Surgery in invasive lobular carcinoma of the breast analysis of the national cancer database ncdb
    Annals of Surgical Oncology, 2021
    Co-Authors: Rita A Mukhtar, Tanya L Hoskin, Elizabeth B Habermann, Courtney N Day, Judy C Boughey
    Abstract:

    Given reports of low response rates to neoadjuvant chemotherapy (NAC) in invasive lobular carcinoma (ILC), we evaluated whether use of alternative strategies such as neoadjuvant endocrine therapy (NET) is increasing. Additionally, we investigated whether NET is associated with more breast conservation Surgery (BCS) and less extensive Axillary Surgery in those with ILC. We queried the NCDB from 2010 to 2016 and identified all women with stage I–III hormone receptor positive, human epidermal growth factor receptor-2 negative (HR+/HER2−) ILC who underwent Surgery. We used Cochrane–Armitage tests to evaluate trends in utilization of the following treatment strategies: NAC, short-course NET, long-course NET, and primary Surgery. We compared rates of BCS and extent of Axillary Surgery stratified by clinical stage and tumor receptor subtype for each treatment strategy. Among 69,312 cases of HR+/HER2− ILC, NAC use decreased slightly (from 4.7 to 4.2%, p = 0.007), while there was a small but significant increase in long-course NET (from 1.6 to 2.7%, p < 0.001). Long-course NET was significantly associated with increased BCS in patients with cT2–cT4 disease and less extensive Axillary Surgery in clinically node positive patients with HR+/HER2− tumors. Primary Surgery remains the most common treatment strategy in patients with ILC. However, NAC use decreased slightly over the study period, while the use of long-course NET had a small increase and was associated with more BCS and less extensive Axillary Surgery.

  • breast cancer related lymphedema risk is related to multidisciplinary treatment and not Surgery alone results from a large cohort study
    Annals of Surgical Oncology, 2017
    Co-Authors: Toan T Nguyen, Elizabeth B Habermann, Tanya L Hoskin, Andrea L Cheville, Judy C Boughey
    Abstract:

    Breast cancer-related lymphedema (BCRL) is a significant complication for women undergoing treatment. We assessed BCRL incidence and risk factors in a large population-based cohort. We utilized the Olmsted County Rochester Epidemiology Project Breast Cancer Cohort from 1990–2010 and ascertained BCRL and risk factors. The cumulative incidence estimator was used to estimate the rate of BCRL; competing risks regression was used for multivariable analysis. A total of 1794 patients with stage 0–3 breast cancer with a median of 10 years follow-up were included. The cumulative incidence of BCRL diagnosis within 5 years was 9.1% [95% confidence interval (CI) 7.8–10.5%]. No BCRL events occurred among patients without Axillary Surgery. In the Axillary Surgery subset (n = 1512), the 5-year incidence of BCRL was 5.3% in sentinel lymph node (SLN) Surgery and 15.9% in Axillary dissection (ALND) patients (p 25% at 5 years) all involved ALND with nodal RT and/or anthracycline/cytoxan + taxane chemotherapy. In multivariable analysis of patients with any Axillary Surgery factors significantly associated with BCRL were ALND, chemotherapy, radiation, and obesity. BCRL is a sequelae of multimodal breast cancer treatment and risk is multifactorial. BCRL rates are higher in patients receiving chemotherapy, radiation, ALND, more advanced disease stage, and higher body mass index.

  • is Axillary Surgery beneficial for patients with adenoid cystic carcinoma of the breast
    Journal of Surgical Oncology, 2017
    Co-Authors: Jessemae L Welsh, Judy C Boughey, Tanya L Hoskin, Michael G Keeney, Katrina N Glazebrook, Sejal M Shah, Tina J Hieken
    Abstract:

    Background and objectives Adenoid cystic carcinoma (ACC) is a rare, typically triple-negative, breast cancer reported to have a favorable prognosis and low rate of nodal metastasis. No consensus guidelines exist for Axillary staging and treatment. Methods We identified all patients with ACC evaluated at our institution from January 1994 to August 2016. Patient, tumor, and treatment variables were abstracted and analyzed. Results We identified 20 pure ACCs (0.13% of all invasive breast cancers) with size range 0.2-4.8 cm, in 19 women, median age 59 years. Preoperative Axillary ultrasound was normal in 10/13 women and suspicious in 3/13 who had a subsequent negative lymph node fine needle aspiration (FNA). Fifteen patients (75%) had sentinel lymph node Surgery and were pathologically node-negative, while the remaining five had no Axillary Surgery. With 3.6 years median follow-up (range 0.2-38.6 years), three patients experienced an in-breast recurrence at 2, 16, and 17 years, respectively, while none recurred in regional nodes. Conclusions We observed no cases of nodal metastasis in 20 consecutive cases of ACC of the breast. Preoperative Axillary ultrasound with FNA of suspicious nodes accurately predicted pathologic nodal stage. These data suggest Axillary Surgery might be omitted safely in patients with pure ACC and a clinically negative axilla.

  • incidence of clinically significant seroma after breast and Axillary Surgery
    Journal of The American College of Surgeons, 2009
    Co-Authors: Sarah Y Boostrom, Alyssa D Throckmorton, Judy C Boughey, Andrea C Holifield, Shaheen Zakaria, Tanya L Hoskin, Amy C Degnim
    Abstract:

    treatment. 3 We hypothesized that seromas occur more frequently in extensive surgical procedures or in those that require a drainage tube. In addition, we theorized that seroma and surgical site infection (SSI) were directly correlated.The aims of this study were to evaluate the frequency of seromas that require intervention, to assess variation based on the extent of the breast or Axillary surgical procedure, and to evaluate the incidence of SSI in relation to seroma occurrence.

Rachel A Greenup - One of the best experts on this subject based on the ideXlab platform.

  • extent of Axillary Surgery in inflammatory breast cancer a survival analysis of 3500 patients
    Breast Cancer Research and Treatment, 2020
    Co-Authors: Oluwadamilola M Fayanju, Laura H Rosenberger, Jennifer K Plichta, Rachel A Greenup, Yi Ren, Jeremy Force
    Abstract:

    Inflammatory breast cancer (IBC) is an aggressive variant for which Axillary lymph node (LN) dissection following neoadjuvant chemotherapy (NACT) remains standard of care. But with increasingly effective systemic therapy, it is unclear whether more limited Axillary Surgery may be appropriate in some IBC patients. We sought to examine whether extent of Axillary LN Surgery was associated with overall survival (OS) for IBC. Female breast cancer patients with non-metastatic IBC (cT4d) diagnosed 2010–2014 were identified in the National Cancer Data Base. Cox proportional hazards modeling was used to estimate the association between extent of Axillary Surgery (≤ 9 vs ≥ 10 LNs removed) and OS after adjusting for covariates, including post-NACT nodal status (ypN0 vs ypN1-3) and radiotherapy receipt (yes/no). 3471 patients were included: 597 (17.2%) had cN0 disease, 1833 (52.8%) had cN1 disease, and 1041 (30%) had cN2-3 disease. 49.9% of cN0 patients were confirmed to be ypN0 on post-NACT surgical pathology. Being ypN0 (vs ypN1-3) was associated with improved adjusted OS for all patients. Radiotherapy was associated with improved adjusted OS for cN1 and cN2-3 patients but not for cN0 patients. Regardless of ypN status, there was a trend towards improved adjusted OS with having ≥ 10 (vs ≤ 9) LNs removed for cN2-3 patients (HR 0.78, 95% CI 0.60–1.01, p = 0.06) but not for cN0 patients (p = 0.83). A majority of IBC patients in our study presented with node-positive disease, and for those presenting with cN2-3 disease, more extensive Axillary Surgery is potentially associated with improved survival. For cN0 patients, however, more extensive Axillary Surgery was not associated with a survival benefit, suggesting an opportunity for more personalized care.

  • the association of extent of Axillary Surgery and survival in women with n2 3 invasive breast cancer
    Annals of Surgical Oncology, 2018
    Co-Authors: Tristen S Park, Samantha M Thomas, Laura H Rosenberger, Oluwadamilola M Fayanju, Jennifer K Plichta, Rachel C Blitzblau, Cecilia T Ong, Terry Hyslop, Shelley E Hwang, Rachel A Greenup
    Abstract:

    Although surgical management of the axilla for breast cancer continues to evolve, Axillary lymphadenectomy remains the standard of care for women with advanced nodal disease. We sought to evaluate national patterns of care in Axillary Surgery, and its association with overall survival (OS) among women with N2–3 invasive breast cancer. Women (18–90 years) with clinical N2–3 invasive breast cancer who underwent Axillary Surgery were identified from the National Cancer Data Base (NCDB) from 2004 to 2013. Axillary Surgery was categorized as sentinel lymph node biopsy (SLNB, 1–5 nodes) or Axillary lymph node dissection (ALND, ≥ 10 nodes). Patient and treatment characteristics, trends over time, and overall survival (OS) were compared by surgical treatment. Overall, 22,156 patients were identified. At diagnosis, 68.5% had cN2 and 31.5% had cN3 disease. Treatment included: lumpectomy (27%), mastectomy (73%), adjuvant chemotherapy (53.4%), neoadjuvant chemotherapy (NAC) (39.7%), radiation (74%), and endocrine therapy (54.4%). In total, 9.9% (n = 2190) underwent SLNB and 90.1% (n = 19,966) underwent ALND. Receipt of SLNB was associated with private insurance, grade 3 disease, invasive ductal cancer, NAC, and lumpectomy (all p < 0.001). After adjustment for known covariates, including chemotherapy use, ALND was associated with improved survival [hazard ratio (HR) 0.68, p < 0.001] and this effect was similar for N2 and N3 patients (Axillary Surgery × cN-stage interaction p = 0.29). Axillary lymphadenectomy was associated with improved survival in patients presenting with clinical N2–3 invasive breast cancer. Further studies, particularly in the neoadjuvant setting, are needed to identify breast cancer patients with advanced nodal disease who may safely avoid a lesser extent of Axillary Surgery.

  • patient age and tumor subtype predict the extent of Axillary Surgery among breast cancer patients eligible for the american college of surgeons oncology group trial z0011
    Annals of Surgical Oncology, 2017
    Co-Authors: Cecilia T Ong, Tristen S Park, Samantha M Thomas, Laura H Rosenberger, Oluwadamilola M Fayanju, Jennifer K Plichta, Rachel C Blitzblau, Terry Hyslop, Shelley E Hwang, Rachel A Greenup
    Abstract:

    The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial established the safety of omitting Axillary lymph node dissection (ALND) for early-stage breast cancer patients with limited nodal disease undergoing lumpectomy. We examined the extent of Axillary Surgery among women eligible for Z0011 based on patient age and tumor subtype. Patients with cT1–2, cN0 breast cancers and one or two positive nodes diagnosed from 2009 to 2014 and treated with lumpectomy were identified in the National Cancer Data Base. Sentinel lymph node biopsy (SLNB) was defined as the removal of 1–5 nodes and ALND as the removal of 10 nodes or more. Tumor subtype was categorized as luminal, human epidermal growth factor 2-positive (HER2+), or triple-negative. Logistic regression was used to estimate the odds of receiving SLNB alone versus ALND. The inclusion criteria were met by 28,631 patients (21,029 SLNB-alone and 7602 ALND patients). Patients 70 years of age or older were more likely to undergo SLNB alone than ALND (27.0% vs 20.1%; p < 0.001). The radiation therapy use rate was 89.4% after SLNB alone and 89.7% after ALND. In the multivariate analysis, the uptake of Z0011 recommendations increased over time (2014 vs 2009: odds ratio [OR] 13.02; p < 0.001). Younger patients were less likely to undergo SLNB alone than older patients (age <40 vs ≥70: OR 0.59; p < 0.001). Patients with HER2+ (OR 0.89) or triple-negative disease (OR 0.79) (p < 0.001) were less likely to undergo SLNB alone than those with luminal subtypes. Among women potentially eligible for ACOSOG Z0011, the use of SLNB alone increased over time in all groups, but the extent of Axillary Surgery differed by patient age and tumor subtype.

Timothy J Whelan - One of the best experts on this subject based on the ideXlab platform.

  • development and validation of a nomogram to predict lymphedema after Axillary Surgery and radiation therapy in women with breast cancer from the ncic ctg ma 20 randomized trial
    International Journal of Radiation Oncology Biology Physics, 2019
    Co-Authors: Jeffrey P Gross, Timothy J Whelan, Wendy R Parulekar, Bingshu E Chen, Alfred Rademaker, Irene Helenowski, Eric D Donnelly, Jonathan B Strauss
    Abstract:

    Purpose Regional nodal irradiation for women with breast cancer is known to be an important risk factor for the development of upper extremity lymphedema, but tools to accurately predict lymphedema risks for individual patients are lacking. This study sought to develop and validate a nomogram to predict lymphedema risk after Axillary Surgery and radiation therapy in women with breast cancer. Methods and Materials Data from 1832 women accrued on the MA.20 trial between March 2000 and February 2007 were used to create a prognostic model with National Cancer Institute Common Toxicity Criteria Version 2.0 grade 2 or higher lymphedema as the primary endpoint. Multivariable logistic regression estimated model performance. External validation was performed on data from a single large academic cancer center (N = 785). Results In the MA.20 trial cohort, 3 risk factors were predictive of lymphedema risk: body mass index (adjusted odds ratio, 1.05 per unit body mass index; 95% confidence interval [CI], 1.03-1.08, P Conclusions The nomogram created from the MA.20 randomized trial data using clinical information may be useful for lymphedema screening and risk stratification for therapeutic intervention trials.

  • effect of radiotherapy after mastectomy and Axillary Surgery on 10 year recurrence and 20 year breast cancer mortality meta analysis of individual patient data for 8135 women in 22 randomised trials
    The Lancet, 2014
    Co-Authors: P Mcgale, C Taylor, C Correa, David J Cutter, F Duane, Marianne Ewertz, Richard Gray, Gurdeep S Mannu, Richard Peto, Timothy J Whelan
    Abstract:

    Summary Background Postmastectomy radiotherapy was shown in previous meta-analyses to reduce the risks of both recurrence and breast cancer mortality in all women with node-positive disease considered together. However, the benefit in women with only one to three positive lymph nodes is uncertain. We aimed to assess the effect of radiotherapy in these women after mastectomy and Axillary dissection. Methods We did a meta-analysis of individual data for 8135 women randomly assigned to treatment groups during 1964–86 in 22 trials of radiotherapy to the chest wall and regional lymph nodes after mastectomy and Axillary Surgery versus the same Surgery but no radiotherapy. Follow-up lasted 10 years for recurrence and to Jan 1, 2009, for mortality. Analyses were stratified by trial, individual follow-up year, age at entry, and pathological nodal status. Findings 3786 women had Axillary dissection to at least level II and had zero, one to three, or four or more positive nodes. All were in trials in which radiotherapy included the chest wall, supraclavicular or Axillary fossa (or both), and internal mammary chain. For 700 women with Axillary dissection and no positive nodes, radiotherapy had no significant effect on locoregional recurrence (two-sided significance level [2p]>0·1), overall recurrence (rate ratio [RR], irradiated vs not, 1·06, 95% CI 0·76–1·48, 2p>0·1), or breast cancer mortality (RR 1·18, 95% CI 0·89–1·55, 2p>0·1). For 1314 women with Axillary dissection and one to three positive nodes, radiotherapy reduced locoregional recurrence (2p Interpretation After mastectomy and Axillary dissection, radiotherapy reduced both recurrence and breast cancer mortality in the women with one to three positive lymph nodes in these trials even when systemic therapy was given. For today's women, who in many countries are at lower risk of recurrence, absolute gains might be smaller but proportional gains might be larger because of more effective radiotherapy. Funding Cancer Research UK, British Heart Foundation, UK Medical Research Council.