Sentinel Node Biopsy Alone or With Axillary Dissection in cT2 cN0/1 Breast Cancer Patients After Primary Chemotherapy: a Prospective Interventional Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Breast Neoplasm Female
- Sponsor
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
- Enrollment
- 353
- Primary Endpoint
- Overall Survival (OS) and Disease-Free Survival (DFS)
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
Many doctors believe that breast cancer patients scheduled for pre-operative chemotherapy whose cancer has spread to the axilla (determined by palpation plus ultrasound) should not receive sentinel node biopsy after chemotherapy, but proceed directly to removal of all the axillary lymph nodes.
In this study, breast cancer patients with operable medium-size cancer (T2) scheduled for pre-operative chemotherapy, and a disease-free or a metastatic axilla, are prospectively assigned to receive sentinel node biopsy as part of their post-chemotherapy surgical treatment (whose main aim is to remove the cancer in the breast).
Irrespective of whether the axilla is disease-free or metastatic before chemotherapy, if the removed sentinel nodes are disease-free on histological examination (pN0) after chemotherapy, then no further axillary treatment is given. If however the sentinel nodes contain cancer, then the other axillary lymph nodes will be removed surgically.
The study hypothesis is that, irrespective of whether the axilla is disease-free or metastatic before chemotherapy, patients with negative axillary sentinel nodes on histological examination (pN0) after chemotherapy, and who are no given further axillary treatment, will do as well as pN1 patients whose axillary lymph nodes are completely removed (a more aggressive treatment).
Investigators
Gabriele Martelli
Principal Investigator
Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
Eligibility Criteria
Inclusion Criteria
- •cT2 cN0/1 breast cancer
- •Scheduled for neoadjuvant chemotherapy,
- •Informed consent,
Exclusion Criteria
- •Previous malignancy at another site
- •Synchronous breast cancer at diagnosis
- •Distant metastasis at diagnosis
- •Clinically involved axilla (cN1) after neoadjuvant chemotherapy
Outcomes
Primary Outcomes
Overall Survival (OS) and Disease-Free Survival (DFS)
Time Frame: Ten years
DFS and OS are reckoned from date of surgery. DFS is time to recurrence or death, whichever occurred first. OS is time to death for any cause. Time is censored for living patients who are event-free at most recent follow up. OS and DFS curves are estimated using the Kaplan-Meier method and compared using the log-rank test. To compare DFS and OS in the SNB only and SNB + AD groups, propensity scores are estimated to account for bias due to non-random assignment to SNB vs SNB + AD
Secondary Outcomes
- Rate of axillary failure in those receiving only sentinel node biopsy(Ten years)