Sentinel node involvement with or without completion axillary lymph node dissection: treatment and pathologic results of randomized SERC trial
Year: 2021
Type: article
Abstract: Based on results of clinical trials, completion ALND (cALND) is frequently not performed for patients with breast conservation therapy and one or two involved sentinel nodes (SN) by micro- or macro-metastases. However, there were limitations despite a conclusion of non-inferiority for cALND omission. No trial had included patients with SN macro-metastases and total mastectomy or with >2 SN macro-metastases. The aim of the study was too analyze treatment delivered and pathologic results of patients included in SERC trial. SERC trial is a multicenter randomized non-inferiority phase-3 trial comparing no cALND with cALND in cT0-1-2, cN0 patients with SN ITC (isolated tumor cells) or micro-metastases or macro-metastases, mastectomy or breast conservative surgery. We randomized 1855 patients, 929 to receive cALND and 926 SLNB alone. No significant differences in patient's and tumor characteristics, type of surgery, and adjuvant chemotherapy (AC) were observed between the two arms. Rates of involved SN nodes by ITC, micro-metastases, and macro-metastases were 5.91%, 28.12%, and 65.97%, respectively, without significant difference between two arms for all criteria. In multivariate analysis, two factors were associated with higher positive non-SN rate: no AC versus AC administered after ALND (OR = 3.32, p < 0.0001) and >2 involved SN versus ≤2 (OR = 3.45, p = 0.0258). Crude rates of positive NSN were 17.62% (74/420) and 26.45% (73/276) for patient's eligible and non-eligible to ACOSOG-Z0011 trial. No significant differences in patient's and tumor characteristics and treatment delivered were observed between the two arms. Higher positive-NSN rate was observed for patients with AC performed after ALND (17.65% for SN micro-metastases, 35.22% for SN macro-metastases) in comparison with AC administered before ALND.
Source: npj Breast Cancer
Authors: Gilles Houvenaeghel, Monique Cohen, Pédro Raro, Jérémy De Troyer, Pierre Gimbergues, Christine Tunon de Lara, Vivien Ceccato, Véronique Vaini-Cowen, Christelle Faure-Virelizier, Frédéric Marchal, Tristan Gauthier, Eva Jouve, Pierrick Theret, Claudia Regis, Philippe Gabelle, Julia Pernaut, Francesco Del Piano, Gauthier D’Halluin, Stéphane Lantheaume, Emile Darai, Bassoodéo Beedassy, Caroline Dhainaut-Speyer, Xavier Martin, Sophie Girard, Richard Villet, Emilie Monrigal, Théophile Hoyek, Jean-François Le Brun, Pierre-Emmanuel Colombo, Agnès Tallet, Jean-Marie Boher, SERC trial group
Institutions: Aix-Marseille Université, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, Institut de Cancérologie de l'Ouest, Centre Jean Perrin, Institut Bergonié, Institut Jean Godinot, Centre Léon Bérard, Hôpital Universitaire Dupuytren, Institut universitaire du cancer de Toulouse Oncopole, Centre Hospitalier de Saint-Quentin, Centre Oscar Lambret, Centre Hospitalier d'Angoulême, Clinique Pasteur, Hôpital Tenon, Groupe Hospitalier Diaconesses Croix Saint-Simon, Clinique Clémentville, Centre François Baclesse, Institut Regional du Cancer de Montpellier, Inserm, Economic & Social Sciences, Health Systems & Medical Informatics, Institut de Recherche pour le Développement
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,170
OpenAlex ID: W3202297579