Impact of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial on Clinical Management of the Axilla in O
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ORIGINAL ARTICLE – BREAST ONCOLOGY
Impact of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial on Clinical Management of the Axilla in Older Breast Cancer Patients: A SEER-Medicare Analysis Holly Caretta-Weyer, BS1, Caprice G. Greenberg, MD, MPH1, Lee G. Wilke, MD1,2, Jennifer Weiss, MD, MS2,3, Noelle K. LoConte, MD2,4, Marquita Decker, MD1, Nicole M. Steffens, MPH1, Maureen A. Smith, MD, MPH, PhD1,2,5,6, and Heather B. Neuman, MD, MS1,2 Department of Surgery, UW Madison School of Medicine and Public Health, Madison, WI; 2UW Carbone Cancer Center, UW Madison School of Medicine and Public Health, Madison, WI; 3Division of Gastroenterology and Hepatology, Department of Medicine, UW Madison School of Medicine and Public Health, Madison, WI; 4Division of Hematology and Oncology, Department of Medicine, UW Madison School of Medicine and Public Health, Madison, WI; 5Department of Population Health Sciences, UW Madison School of Medicine and Public Health, Madison, WI; 6Department of Family Medicine, UW Madison School of Medicine and Public Health, Madison, WI 1
ABSTRACT Background. American College of Surgeons Oncology Group (ACOSOG) Z0011 demonstrated that eligible breast cancer patients with positive sentinel lymph nodes (SLN) could be spared an axillary lymph node dissection (ALND) without sacrificing survival or local control. Although heralded as a ‘‘practice-changing trial,’’ some argue that the stringent inclusion criteria limit the trial’s clinical significance. The objective was to assess the potential impact of ACOSOG Z0011 on axillary surgical management of Medicare patients and examine current practice patterns. Methods. Medicare beneficiaries aged C66 years with nonmetastatic invasive breast cancer diagnosed from 2001 to 2007 were identified from the Surveillance, Epidemiology and End Results-Medicare database (n = 59,431). Eligibility for ACOSOG Z0011 was determined: SLN mapping, tumor \5 cm, no neoadjuvant treatment, breast conservation; number of positive nodes was determined. Actual surgical axillary management for eligible patients was assessed. Results. Twelve percent (6,942/59,431) underwent SLN mapping and were node positive. Overall, 2,637 patients
Ó Society of Surgical Oncology 2013 First Received: 17 June 2013; Published Online: 20 August 2013 H. B. Neuman, MD, MS e-mail: [email protected]
(4.4 % (2,637/59,431) of the total cohort, but 38 % (2,637/ 6,942) of patients with SLN mapping and positive nodes) met inclusion criteria for ACOSOG Z0011, had 1 or 2 positive lymph nodes, and could have been spared an ALND. Of these 2,637 patients, 46 % received a completion ALND and 54 % received only SLN biopsy. Conclusions. Widespread implementation of ACOSOG Z0011 trial results could potentially spare 38 % of older breast cancer patients who undergo SLN mapping with positive lymph nodes an ALND. However, 54 % of these patients are already managed with SLN biopsy alone, lessening the impact of this trial on clinical practice in older breast cancer patients.
Sentinel lymph node (S
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