Julia R. White, MD, Professor of Radiation Oncology, Medical College of Wisconsin, Medical Director, Radiation Oncology, Community Memorial Hospital, discusses exceptions to the Z11 trial, which looked at sentinel node positive patients that received either axillary lymph node dissection (ALND) or observation.

Patients with tumors larger than T1, young age, and hormone receptor negative, were not well represented in this trial. These patients can have a higher rate of non-sentinel nodes at the time of the complete ALND. If no complete ALND is planned the radiation needs to be adjusted by a multidisciplinary team for the best results.

Large T2 tumors, lymphovascular invasion, ER-negative, and very young patients may need their radiation therapy adjusted using 3D-conformal radiation planning to customize the tangent fields to include the level 1 and 2 axilla.

For even higher risk patients, with 3 or more positive nodes, the complete ALND may still need to be considered. These patients may also warrant comprehensive radiation that includes the super calvicula and the entire axilla.

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Dr. Julia White from Community Memorial Hospital Discusses Exceptions in the Z11 Trial

Dr. White Discusses Exceptions in the Z11 Trial

Julia R. White, MD, Professor of Radiation Oncology, Medical College of Wisconsin, Medical Director, Radiation Oncology, Community Memorial Hospital, discusses the radiation findings from the Z11 randomized trial looking at sentinel node positive patients that received either axillary node dissection or observation.

The trial found axillary node recurrence did not change based on dissection. The survival and recurrence rates were similar in both arms. The trial suggests that sentinel node biopsy is sufficient alone in patients with T1, HR-positive, with no lymphovascular invasion, that will be receiving breast irradiation.

It is possible that the standard breast irradiation accounts for the low levels of recurrence. In the process of standard radiation a corner of the axilla does receive radiation that reaches 25-50% of levels 1 and 2 in the axilla. This portion of the axilla is generally the area removed during dissection.

For patients meeting the Z11 criteria it is possible to provide sufficient axillary control with breast irradiation alone without the need for dissection. The radiation oncologist should not change their practice based on the Z11 results.

Dr. Julia R. White from the Medical College of Wisconsin, Discusses the Z11 Trial Radiation Findings

Julia R. White, MD

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Dr. White Discusses Exceptions in the Z11 Trial

Dr. White Discusses the Z11 Trial Radiation Findings