Importance The results of the American College of Surgeons Oncology Group Z (ACOSOG Z) trial were first reported in with a. The American College of Surgeons Oncology Group (ACOSOG) Z trial was a multicenter noninferiority study which enrolled and. ABSTRACT. Introduction. The ACOSOG Z trial has been described as practice-changing. The goal of this study was to determine the.

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Sentinel lymph node biopsy is a commonly used method of detecting micrometastatic axillary disease at initial presentation.

Consistent with this finding, the incremental decreases in disease-free survival 3. Thus, although nodal irradiation may be added to the management of some patients with node-positive tumors based on an evaluation of their overall risk profile, the routine use of nodal irradiation for all patients with 1 or 2 sentinel node metastases managed with SLND alone may not be justified.

Navigation menu Personal tools Create account Log in. Conflict of Interest Disclosures: Giuliano AE, et al. Create a free personal account to download free article PDFs, sign up for alerts, and more.


Register for email alerts with links to free full-text articles Access PDFs of free articles Manage your interests Save searches and receive search alerts. Impact of the American College of Surgeons Oncology Group Z randomized trial on the number of axillary nodes removed for patients with early-stage breast cancer.

Data quality was ensured by review of data by the Alliance Statistics and Data Center and by the study chairperson following Alliance policies. Disease-free survival and locoregional recurrence have been reported. However, these conclusions apply only to patients meeting ACOSOG Z eligibility criteria and should not be extrapolated to the management of patients with positive palpable nodes, those with metastases in more than 2 sentinel nodes, patients forgoing whole-breast irradiation, those treated with mastectomy without radiation, or patients receiving neoadjuvant therapy because all of these are circumstances in which the elimination of ALND is not known to be safe.

The majority of patients were postmenopausal with hormone receptor—positive breast cancer, raising concern that additional follow-up beyond 6 years was needed to document noninferiority of overall survival with SLND alone in this node-positive cohort. Furthermore, due to low accrual and the low event rate, the study did not reach the prespecified sample size of participants or deaths.

Annual hazard rates of recurrence for breast cancer during 24 years of follow-up: The secondary outcome was disease-free survival. To determine whether the year overall survival of patients with sentinel lymph node metastases treated with breast-conserving therapy and sentinel lymph node dissection SLND alone without axillary lymph node dissection ALND is noninferior to that of women treated with axillary dissection.


This page was last modified on 6 Septemberat In an unplanned analysis of the subset of the patients with detailed radiation records available, those treated with nodal-field irradiation experienced no difference in disease-free survival, overall survival, or locoregional recurrence compared with those who did not receive irradiation.

Breast Cancer Res Treat. In that study, age younger than 50 years and a triple-negative subtype predicted a greater use of ALND, a practice neither supported by the reported 5-year outcomes of ACOSOG Z, 9 nor by the findings of the current report.

Purchase access Subscribe to the journal. Anderson Cancer Center, Houston.

ACOSOG Z – Wiki Journal Club

Regional nodal irradiation in early-stage breast cancer. Sign in to save your search Sign in to your personal account. Eligible patients were women with clinical T1 or T2 invasive breast cancer, no palpable axillary adenopathy, and 1 or 2 sentinel lymph nodes containing metastases.

Disease-free survival was analyzed with a log-rank analysis using Kaplan-Meier curves and unadjusted and multivariable Cox regression analyses. The study and design end points have been described elsewhere. A population-based study of the effects of a regional guideline for completion axillary lymph node dissection on axillary surgery in patients with breast cancer. Patients were randomized to either completion ALND with a minimum of 10 nodes, or to observation.

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Design, Setting, and Participants: These findings do not support routine use of axillary lymph node dissection in this patient population based on year outcomes. Create a free personal account to make a comment, download free article PDFs, sign up for alerts and more. Age and receptor status do not indicate the need for axillary dissection in patients with sentinel lymph node metastases.

Anderson Cancer Center, Houston. Like most large randomized trials in breast cancer management, not all biological subtypes are represented in large numbers.

Although the initial results of the ACOSOG Z study generated controversy, 1718 management of women in the United States with sentinel node metastases changed substantially as a result of the study. Dr Ballman also reported receiving grant support from the National Cancer Institute during the conduct of the study.

Ten years of follow-up confirm that women with 1 or 2 positive sentinel nodes and clinical Yrial or T2 tumors undergoing lumpectomy with whole-breast irradiation and systemic therapy experience no worse local control, disease-free survival, or overall survival with elimination of ALND.


Axillary lymph node dissection ALNDlong used to identify women with axillary nodal metastases, was replaced as a staging procedure by the less morbid sentinel lymph node dissection SLND. Among T breast cancer patients with a positive sentinel lymph node biopsy undergoing lumpectomy and whole-breast radiation, does axillary lymph node dissection improve survival or local control compared to nodal observation?

The National Cancer Institute had a role in the design acospg conduct of the study; collection, management, analysis, and z0011 of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Annual mammography was required; other testing was based on individual symptoms or by investigator preference.

The Journal of the American Medical Association. The secondary outcome was disease-free survival. Low-dose oral cyclophosphamide and methotrexate maintenance for hormone receptor-negative early breast cancer: The stability of these results over time is acoog because patients with hormone receptor—positive breast cancer, who comprise the majority of study participants and the majority of breast cancer patients in the United States, are known to be at prolonged risk for disease recurrence.

The initial study results, reported after a median follow-up of 6.

Sign in to customize your interests Sign in to your personal account. Patterns of frial surgical care for breast cancer in the era of sentinel lymph node biopsy.

All secondary analyses were tested for differences. Drs Giuliano and Ballman had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the tria, analysis. Rao and coauthors conducted a review of the literature to summarize evidence regarding the role of axillary interventions surgical and nonsurgical in breast cancer treatment and to review the association of these axillary interventions with recurrence of axillary node metastases, mortality, and morbidity outcomes in patients with breast cancer.

As a secondary analysis, known prognostic factors including adjuvant treatment were included in the Cox regression model to generate an adjusted HR for overall survival. In an adjusted analysis, well documented prognostic factors such as age, hormone receptor status, tumor size, and the use of adjuvant therapy but not elimination of ALND were associated with overall survival.