ArticleAnnals of surgery2017
Axillary Dissection and Nodal Irradiation Can Be Avoided for Most Node-positive Z0011-eligible Breast Cancers: A Prospective Validation Study of 793 Patients.
Article in Annals of surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
53 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Uncertainties and controversies in axillary management of patients with breast cancer.Cancer treatment reviews · 2023Pooled it
- Axillary Management and Outcomes After Neoadjuvant Endocrine Therapy in the Randomized PELOPS Trial.Annals of surgical oncology · 2026Trial
- Sentinel Lymph Node Biopsy Alone is Adequate for Chemotherapy Decisions in Postmenopausal Early-Stage Hormone-Receptor-Positive, HER2-Negative Breast Cancer with One to Three Positive Sentinel Lymph Nodes.Annals of surgical oncology · 2022Trial
- ALND Experience During Breast Surgical Oncology Fellowship over the Years: An SSO/ASBrS Collaborative Analysis.Annals of surgical oncology · 2026Article
- Review
- Article
- Preoperative Axillary Ultrasound in the Era of Z0011: A Model for Predicting High Axillary Disease Burden.Current oncology (Toronto, Ont.) · 2025Article
- Article
- Clinical impact of the Z0011 trial on axillary surgical management in Australia and New Zealand from the BreastSurgANZ Quality Audit.ANZ journal of surgery · 2025Article
- Are Clinically Node-Negative Patients with a Positive Preoperative Axillary Lymph Node Biopsy Appropriate Candidates for Sentinel Lymph Node Biopsy?Annals of surgical oncology · 2025Article
- Intraoperative spectroscopic evaluation of sentinel lymph nodes in breast cancer surgery.Breast cancer research and treatment · 2024Article
- The Role of Axillary Lymph Node Dissection versus Sentinel Lymph Node Dissection in Breast Cancer Patients with Clinical N2b-N3c Disease Who Receive Adjuvant Radiotherapy.Annals of surgical oncology · 2024Article
- Article
- The Role of Post-Mastectomy Radiotherapy in T1-2N1 Breast Cancer Patients: Propensity Score Matched Analysis.Cancers · 2023Article
- Axillary Surgical Attitude Changing with Retrospective Application ofEuropean journal of breast health · 2023Article
- Locoregional Treatment for Early-Stage Breast Cancer: Current Status and Future Perspectives.Current oncology (Toronto, Ont.) · 2023Review
- Comparison of survival outcomes between axillary conservation and axillary lymph node dissections in N1 early breast cancer: a propensity-matched SEER analysis.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2023Article
- Article
- How Often Do Sentinel Lymph Node Biopsy Results Affect Adjuvant Therapy Decisions Among Postmenopausal Women with Early-Stage HRAnnals of surgical oncology · 2022Article
- Breast surgery: a narrative review.The Medical journal of Australia · 2022Review
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Authors and funding
17 authors.
Funding
Abstract
objectiveTo determine rates of axillary dissection (ALND) and nodal recurrence in patients eligible for ACOSOG Z0011.
backgroundZ0011 demonstrated that patients with cT1-2N0 breast cancers and 1 to 2 involved sentinel lymph nodes (SLNs) having breast-conserving therapy had no difference in locoregional recurrence or survival after SLN biopsy alone or ALND. The generalizability of the results and importance of nodal radiotherapy (RT) is unclear.
methodsPatients eligible for Z0011 had SLN biopsy alone. Prospectively defined indications for ALND were metastases in ≥3 SLNs or gross extracapsular extension. Axillary imaging was not routine. SLN and ALND groups and radiation fields were compared with chi-square and t tests. Cumulative incidence of recurrences was estimated with competing risk analysis.
resultsFrom August 2010 to December 2016, 793 patients met Z0011 eligibility criteria and had SLN metastases. Among them, 130 (16%) had ALND; ALND did not vary based on age, estrogen receptor, progesterone receptor, or HER2 status. Five-year event-free survival after SLN alone was 93% with no isolated axillary recurrences. Cumulative 5-year rates of breast + nodal and nodal + distant recurrence were each 0.7%. In 484 SLN-only patients with known RT fields (103 prone, 280 supine tangent, 101 breast + nodes) and follow-up ≥12 months, the 5-year cumulative nodal recurrence rate was 1% and did not differ significantly by RT fields.
conclusionsWe confirm that even without preoperative axillary imaging or routine use of nodal RT, ALND can be avoided in a large majority of Z0011-eligible patients with excellent regional control. This approach has the potential to spare substantial numbers of women the morbidity of ALND.
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