Active surveillance of patients who have melanoma with a positive sentinel node in an era of effective adjuvant therapy: Early lessons learned … and still learning

Cancer ◽  
2021 ◽  
Author(s):  
Jeffrey E. Gershenwald
Keyword(s):  
Adjuvant Therapy ◽  
Sentinel Node ◽  
Active Surveillance ◽  
Lessons Learned ◽  
Positive Sentinel Node

scholarly journals POSNOC—POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054365
Author(s):  
Amit Goyal ◽  
G Bruce Mann ◽  
Lesley Fallowfield ◽  
Lelia Duley ◽  
Malcolm Reed ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Assurance ◽  
Adjuvant Therapy ◽  
Sentinel Node ◽  
Axillary Recurrence ◽  
Positive Sentinel Node ◽  
Link Type ◽  
Axillary Node Clearance ◽  
Axillary Radiotherapy ◽  
Axillary Treatment

IntroductionACOSOG-Z0011(Z11) trial showed that axillary node clearance (ANC) may be omitted in women with ≤2 positive nodes undergoing breast conserving surgery (BCS) and whole breast radiotherapy (RT). A confirmatory study is needed to clarify the role of axillary treatment in women with ≤2 macrometastases undergoing BCS and groups that were not included in Z11 for example, mastectomy and those with microscopic extranodal invasion. The primary objective of POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy (POSNOC) is to evaluate whether for women with breast cancer and 1 or 2 macrometastases, adjuvant therapy alone is non-inferior to adjuvant therapy plus axillary treatment, in terms of 5-year axillary recurrence.Methods and analysisPOSNOC is a pragmatic, multicentre, non-inferiority, international trial with participants randomised in a 1:1 ratio. Women are eligible if they have T1/T2, unifocal or multifocal invasive breast cancer, and 1 or 2 macrometastases at sentinel node biopsy, with or without extranodal extension. In the intervention group women receive adjuvant therapy alone, in the standard care group they receive ANC or axillary RT. In both groups women receive adjuvant therapy, according to local guidelines. This includes systemic therapy and, if indicated, RT to breast or chest wall. The UK Radiotherapy Trials Quality Assurance Group manages the in-built radiotherapy quality assurance programme. Primary endpoint is 5-year axillary recurrence. Secondary outcomes are arm morbidity assessed by Lymphoedema and Breast Cancer Questionnaire and QuickDASH questionnaires; quality of life and anxiety as assessed with FACT B+4 and State/Trait Anxiety Inventory questionnaires, respectively; other oncological outcomes; economic evaluation using EQ-5D-5L. Target sample size is 1900. Primary analysis is per protocol. Recruitment started on 1 August 2014 and as of 9 June 2021, 1866 participants have been randomised.Ethics and disseminationProtocol was approved by the National Research Ethics Service Committee East Midlands—Nottingham 2 (REC reference: 13/EM/0459). Results will be submitted for publication in peer-reviewed journals.Trial registration numberISRCTN54765244; NCT0240168Cite Now

scholarly journals Role of Axillary Clearance After a Tumor-Positive Sentinel Node in the Administration of Adjuvant Therapy in Early Breast Cancer

2010 ◽  
Vol 28 (5) ◽  
pp. 731-737 ◽  
Author(s):  
Marieke E. Straver ◽  
Philip Meijnen ◽  
Geertjan van Tienhoven ◽  
Cornelis J.H. van de Velde ◽  
Robert E. Mansel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Adjuvant Therapy ◽  
Sentinel Node ◽  
Early Breast Cancer ◽  
Systemic Therapy ◽  
Adjuvant Systemic Therapy ◽  
Positive Sentinel Node ◽  
Random Assignment ◽  
Nodal Involvement

Purpose The After Mapping of the Axilla: Radiotherapy or Surgery? (AMAROS) phase III study compares axillary lymph node dissection (ALND) and axillary radiation therapy (ART) in early breast cancer patients with tumor-positive sentinel nodes. In the ART arm, the extent of nodal involvement remains unknown, which could have implications on the administration of adjuvant therapy. In this preliminary analysis, we studied the influence of random assignment to ALND or ART on the choice for adjuvant treatment. Patients and Methods In the first 2,000 patients enrolled in the AMAROS trial, we analyzed the administration of adjuvant systemic therapy. Multivariate analysis was used to assess variables affecting the administration of adjuvant chemotherapy. Adjuvant therapy was applied according to institutional guidelines. Results Of 2,000 patients, 566 patients had a positive sentinel node and were treated per random assignment. There was no significant difference in the administration of adjuvant systemic therapy. In the ALND and ART arms, 58% (175 of 300) and 61% (162 of 266) of the patients, respectively, received chemotherapy. Endocrine therapy was administered in 78% (235 of 300) of the patients in the ALND arm and in 76% (203 of 266) of the patients in the ART arm. Treatment arm was not a significant factor in the decision, and no interactions between treatment arm and other factors were observed. Multivariate analysis showed that age, tumor grade, multifocality, and size of the sentinel node metastasis significantly affected the administration of chemotherapy. Within the ALND arm, the extent of nodal involvement remained not significant in a sensitivity multivariate analysis. Conclusion Absence of knowledge regarding the extent of nodal involvement in the ART arm appears to have no major impact on the administration of adjuvant therapy.

scholarly journals 483 Should we re-stage after positive sentinel node biopsy on endometrial cancer?

2020 ◽  
Author(s):  
Mikel Gorostidi ◽  
Rubén Ruiz Sautua ◽  
Ibon Jaunarena ◽  
Paloma Cobas ◽  
Arantxa Lekuona
Keyword(s):  
Endometrial Cancer ◽  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Positive Sentinel Node ◽  
Node Biopsy
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