Assisting Community-Based Oncologists and Surgeons in Making Neoadjuvant Treatment Decisions for Patients with Early Breast CancerAxillary node dissection in a patient with a positive sentinel node biopsy after neoadjuvant treatment
1:05 minutes.
TRANSCRIPTION:
DR BLACKWELL: I think it’s an important point that you can’t apply the principles of studies like Z11 on patients who’ve had neoadjuvant therapy. And frequently I see a patient who got neoadjuvant therapy, goes to sentinel node and has 2 of 2 positive lymph nodes and comes to see me because they realized their local oncologist has said, “What do I do now? There’s still positive axillary lymph nodes.” And, let’s say, TAC chemotherapy in the neoadjuvant setting. And the surgeon has applied Z11 to that patient. That is really, in my mind, not an acceptable approach. That patient needs a completion dissection. And so you can’t really apply a patient who’s had a lumpectomy and has 2 out of 3 positive lymph nodes after neoadjuvant chemotherapy who’s going to get Level 1 axillary radiation therapy. That’s an inappropriate application of Z11 in the sense that you can’t apply the Z11 standards to patients who have had neoadjuvant therapy. |