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M. Castelo, S. Hu, F. Dossa, S. Acuna, A. Scheer (2020)
Comparing Observation, Axillary Radiotherapy, and Completion Axillary Lymph Node Dissection for Management of Axilla in Breast Cancer in Patients with Positive Sentinel Nodes: A Systematic ReviewAnnals of Surgical Oncology, 27
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Ann Surg Oncol (2020) 27:2677–2678 https://doi.org/10.1245/s10434-020-08394-w ASO A UTHOR R EFLECTIONS ASO Author Reflections: Completion Axillary Dissection Can Be Avoided but Inconsistent Trial Design Complicates Choosing Between Alternative Strategies 1,2,3,4 1,2,3,4 Matthew Castelo, MD , and Adena S. Scheer, MD, MSc Division of General Surgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada; Department of Surgery, St. Michael’s Hospital, Toronto, ON, Canada PAST comparing observation or ART with cALND in sentinel- node-positive women with a particular focus on assessing The highly publicized randomized controlled trial bias specific to noninferiority trials. (RCT) American College of Surgeons Oncology Group (ACOSOG) Z0011 seemingly established the oncologic PRESENT safety of omitting completion axillary lymph node dissec- tion (cALND) for sentinel-node-positive women who were We identified six RCTs that met our inclusion criteria. cN0. However, debate around this trial’s early termination Two trials of women with micrometastatic axillary disease and radiation field protocol violations eclipsed a more compared observation with cALND. These trials demon- comprehensive assessment of the remaining randomized
Annals of Surgical Oncology – Springer Journals
Published: Aug 1, 2020
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