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Breast Cancer • Radiation Oncology
How do you treat women who have breast-conserving surgery with positive sentinel node/s and no axillary dissection?
After the publication of ACOSOG Z11 we are seeing these patients in increasing numbers.
Answer from: Radiation Oncologist at Academic Institution
Three separate points to make: 1. Z-11 is often misquoted. The Z-11 trial did not randomize patients to plus or minus nodal radiation. That question was asked in the MA 20 study. In the MA 20 study, as well as a few other studies, the addition of regional radiation provides a meaningful impact on ou...
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Answer from: Radiation Oncologist at Academic Institution
My understanding of this literature is very similar to @Lawrence B. Marks, whose answer I wholeheartedly support.Z-11 asked and answered a surgical question. In clinically node (-) women with 1-2 + SLNs, there was no benefit to ALNDx. Some people note that in Z-11 the regional nodal recurrence rate ...
Answer from: Radiation Oncologist at Community Practice
Since this has been adopted as standard of care by breast surgeons and ASCO guidelines, this would be norm rather than the exception. Even though not required in the Z 11 protocol, some radiation oncologists did modify field treated including variable nodal volume which makes data interpretation dif...
Answer from: Radiation Oncologist at Community Practice
I agree with @Sushil Beriwal, in general. Where I struggle is when to add the superclav field. For micro mets, I never do, but even if technically a macro met (2mm), if the MRI didn't demonstrate any other obvious positive nodes, I may still just use high tangents.
The new question...
Answer from: Radiation Oncologist at Academic Institution
It may be worth mentioning that the radiation field designs from the ACOSOG Z0011 trial were recently reported:http://www.ncbi.nlm.nih.gov/pubmed/25135994
Answer from: Radiation Oncologist at Academic Institution
The ACOSOG Z0011 article doesn't really address the question on whether nodes were treated. When you look at radiation therapy treatment planning books, the axillary targets often will extend to the humerus. High tangents were described as up to within 2 cm of the humerus.
Answer from: Radiation Oncologist at Community Practice
Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS):a randomised, multicentre, open-label, phase 3non-inferiority trial This is the trial that gave me the comfort of treating patients with +SLN with RT without an axillary dissection. "Ax...