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Axillary Dissection, Nodal Recurrence and Extent of RT in Z0011 Eligible Breast Cancer Patients: A Prospective Study
Monica Morrow, Kimberly Van Zee, Melissa Pilewskie, Mahmoud El-Tamer, Andrea Barrio, George Plitas, Lisa Sclafani, Laurie Kirstein, Sujata Patil, Hiram Cody, III
Memorial Sloan Kettering Cancer Center, NY, NY

OBJECTIVE(S): ACOSOG Z0011 established the safety of sentinel node biopsy (SLNB) alone in cT1-2N0 patients with 1-2 SLN+ undergoing breast conservation therapy (BCT), but concerns remain about patient selection and the role of RT. We prospectively assessed patterns of ALND and nodal recurrence in consecutive Z0011 eligible patients with known RT fields. METHODS: From 9/2010 to 3/2016 723 patients met Z0011 criteria, had BCT and were SLN+; 125 (17%) had ALND (86 for ≥3 SLN+, 33 for extracapsular extension, 6 by surgeon choice) and 598 (83%) did not. RESULTS: ALND was not more frequent in “high risk” (triple negative, HER2+, age <50) than non-high risk patients: 15.5% vs 15.9% (p=0.89). Of 598 SLNB-only patients, 430 had followup ≥12 mo (median 33, range 12-68) and complete RT data. There were no isolated axillary failures and 5 coincident with breast or distant relapse. 5-year nodal recurrence-free survival was 98% and did not differ by RT fields (Table). CONCLUSIONS: Most BCT patients with cT1-2N0 breast cancer and positive SLNs do not require ALND, and regional control is excellent with selective nodal RT. Our prospective data suggest that 1) wider acceptance of Z0011 will further decrease the morbidity of breast cancer surgery and 2) nodal RT for Z0011 patients need not be routine.
Nodal Recurrence by Patient Characteristics and RT Fields
RT (n=430)
Prone breastSupine breastBreast+nodesp
# pts (%)94 (22%)254 (59%)82 (19%)
age (median)555957.23
pT size (cm)1.5 cm1.6 cm2.0 cm.001
# SLN+ (median)111.0003
LVI %535772.027
ECE %172852<.0001
Stage >IIa273148<.0001
nodal relapse # (%)03 (1.2%)2 (2.4%).32

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