Is axillary lymph node dissection indicated for early-stage breast cancer? A decision analysis

Giovanni Parmigiani, Donald A. Berry, Eric P. Winer, Claudia Tebaldi, J. Dirk Iglehart, Leonard R. Prosnitz

Research output: Contribution to journalArticle

Abstract

Purpose: Axillary lymph node dissection (ALND) has been a standard procedure in the management of breast cancer. In a patient with a clinically negative axilla, ALND is performed primarily for staging purposes, to guide adjuvant treatment. Recently, the routine use of ALND has been questioned because the results of the procedure may not change the choice of adjuvant systemic therapy and/or the survival benefit of a change in adjuvant therapy would be small. We constructed a decision model to quantify the benefits of ALND for patients eligible for breast-conserving therapy. Methods: Patients were grouped by age, tumor size, and estrogen receptor (ER) status. The model uses the Oxford overviews and three combined Cancer and Leukemia Group B studies. We assumed that patients who did not undergo ALND received axillary radiation therapy and that the two procedures are equally effective. All chemotherapy combinations were assumed to be equally efficacious. Results: The largest benefits from ALND are seen in ER-positive women with small primary tumors who might not be candidates for adjuvant chemotherapy if their lymph nodes test negative. Virtually no benefit results in ER-negative women, almost all of whom would receive adjuvant chemotherapy. When adjusted for quality of life (QOL), ALND may have an overall negative impact. In general, the benefits of ALND increase with the expected severity of adjuvant therapy on QOL. Conclusion: Our model quantifies the benefits of ALND and assists decision making by patients and physicians. The results suggest that the routine use of ALND in breast cancer patients should be reassessed and may not be necessary in many patients.

Original languageEnglish (US)
Pages (from-to)1465-1473
Number of pages9
JournalJournal of Clinical Oncology
Volume17
Issue number5
StatePublished - 1999
Externally publishedYes

Fingerprint

Decision Support Techniques
Lymph Node Excision
Breast Neoplasms
Estrogen Receptors
Adjuvant Chemotherapy
Quality of Life
Therapeutics
Neoplasms
Axilla
Combination Drug Therapy
Decision Making
Leukemia
Breast
Radiotherapy
Lymph Nodes
Physicians
Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Parmigiani, G., Berry, D. A., Winer, E. P., Tebaldi, C., Iglehart, J. D., & Prosnitz, L. R. (1999). Is axillary lymph node dissection indicated for early-stage breast cancer? A decision analysis. Journal of Clinical Oncology, 17(5), 1465-1473.

Is axillary lymph node dissection indicated for early-stage breast cancer? A decision analysis. / Parmigiani, Giovanni; Berry, Donald A.; Winer, Eric P.; Tebaldi, Claudia; Iglehart, J. Dirk; Prosnitz, Leonard R.

In: Journal of Clinical Oncology, Vol. 17, No. 5, 1999, p. 1465-1473.

Research output: Contribution to journalArticle

Parmigiani, G, Berry, DA, Winer, EP, Tebaldi, C, Iglehart, JD & Prosnitz, LR 1999, 'Is axillary lymph node dissection indicated for early-stage breast cancer? A decision analysis', Journal of Clinical Oncology, vol. 17, no. 5, pp. 1465-1473.
Parmigiani G, Berry DA, Winer EP, Tebaldi C, Iglehart JD, Prosnitz LR. Is axillary lymph node dissection indicated for early-stage breast cancer? A decision analysis. Journal of Clinical Oncology. 1999;17(5):1465-1473.
Parmigiani, Giovanni ; Berry, Donald A. ; Winer, Eric P. ; Tebaldi, Claudia ; Iglehart, J. Dirk ; Prosnitz, Leonard R. / Is axillary lymph node dissection indicated for early-stage breast cancer? A decision analysis. In: Journal of Clinical Oncology. 1999 ; Vol. 17, No. 5. pp. 1465-1473.
@article{57471589c9fe4677b9e0a72412986ec7,
title = "Is axillary lymph node dissection indicated for early-stage breast cancer? A decision analysis",
abstract = "Purpose: Axillary lymph node dissection (ALND) has been a standard procedure in the management of breast cancer. In a patient with a clinically negative axilla, ALND is performed primarily for staging purposes, to guide adjuvant treatment. Recently, the routine use of ALND has been questioned because the results of the procedure may not change the choice of adjuvant systemic therapy and/or the survival benefit of a change in adjuvant therapy would be small. We constructed a decision model to quantify the benefits of ALND for patients eligible for breast-conserving therapy. Methods: Patients were grouped by age, tumor size, and estrogen receptor (ER) status. The model uses the Oxford overviews and three combined Cancer and Leukemia Group B studies. We assumed that patients who did not undergo ALND received axillary radiation therapy and that the two procedures are equally effective. All chemotherapy combinations were assumed to be equally efficacious. Results: The largest benefits from ALND are seen in ER-positive women with small primary tumors who might not be candidates for adjuvant chemotherapy if their lymph nodes test negative. Virtually no benefit results in ER-negative women, almost all of whom would receive adjuvant chemotherapy. When adjusted for quality of life (QOL), ALND may have an overall negative impact. In general, the benefits of ALND increase with the expected severity of adjuvant therapy on QOL. Conclusion: Our model quantifies the benefits of ALND and assists decision making by patients and physicians. The results suggest that the routine use of ALND in breast cancer patients should be reassessed and may not be necessary in many patients.",
author = "Giovanni Parmigiani and Berry, {Donald A.} and Winer, {Eric P.} and Claudia Tebaldi and Iglehart, {J. Dirk} and Prosnitz, {Leonard R.}",
year = "1999",
language = "English (US)",
volume = "17",
pages = "1465--1473",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "5",

}

TY - JOUR

T1 - Is axillary lymph node dissection indicated for early-stage breast cancer? A decision analysis

AU - Parmigiani, Giovanni

AU - Berry, Donald A.

AU - Winer, Eric P.

AU - Tebaldi, Claudia

AU - Iglehart, J. Dirk

AU - Prosnitz, Leonard R.

PY - 1999

Y1 - 1999

N2 - Purpose: Axillary lymph node dissection (ALND) has been a standard procedure in the management of breast cancer. In a patient with a clinically negative axilla, ALND is performed primarily for staging purposes, to guide adjuvant treatment. Recently, the routine use of ALND has been questioned because the results of the procedure may not change the choice of adjuvant systemic therapy and/or the survival benefit of a change in adjuvant therapy would be small. We constructed a decision model to quantify the benefits of ALND for patients eligible for breast-conserving therapy. Methods: Patients were grouped by age, tumor size, and estrogen receptor (ER) status. The model uses the Oxford overviews and three combined Cancer and Leukemia Group B studies. We assumed that patients who did not undergo ALND received axillary radiation therapy and that the two procedures are equally effective. All chemotherapy combinations were assumed to be equally efficacious. Results: The largest benefits from ALND are seen in ER-positive women with small primary tumors who might not be candidates for adjuvant chemotherapy if their lymph nodes test negative. Virtually no benefit results in ER-negative women, almost all of whom would receive adjuvant chemotherapy. When adjusted for quality of life (QOL), ALND may have an overall negative impact. In general, the benefits of ALND increase with the expected severity of adjuvant therapy on QOL. Conclusion: Our model quantifies the benefits of ALND and assists decision making by patients and physicians. The results suggest that the routine use of ALND in breast cancer patients should be reassessed and may not be necessary in many patients.

AB - Purpose: Axillary lymph node dissection (ALND) has been a standard procedure in the management of breast cancer. In a patient with a clinically negative axilla, ALND is performed primarily for staging purposes, to guide adjuvant treatment. Recently, the routine use of ALND has been questioned because the results of the procedure may not change the choice of adjuvant systemic therapy and/or the survival benefit of a change in adjuvant therapy would be small. We constructed a decision model to quantify the benefits of ALND for patients eligible for breast-conserving therapy. Methods: Patients were grouped by age, tumor size, and estrogen receptor (ER) status. The model uses the Oxford overviews and three combined Cancer and Leukemia Group B studies. We assumed that patients who did not undergo ALND received axillary radiation therapy and that the two procedures are equally effective. All chemotherapy combinations were assumed to be equally efficacious. Results: The largest benefits from ALND are seen in ER-positive women with small primary tumors who might not be candidates for adjuvant chemotherapy if their lymph nodes test negative. Virtually no benefit results in ER-negative women, almost all of whom would receive adjuvant chemotherapy. When adjusted for quality of life (QOL), ALND may have an overall negative impact. In general, the benefits of ALND increase with the expected severity of adjuvant therapy on QOL. Conclusion: Our model quantifies the benefits of ALND and assists decision making by patients and physicians. The results suggest that the routine use of ALND in breast cancer patients should be reassessed and may not be necessary in many patients.

UR - http://www.scopus.com/inward/record.url?scp=0032948554&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032948554&partnerID=8YFLogxK

M3 - Article

C2 - 10334532

AN - SCOPUS:0032948554

VL - 17

SP - 1465

EP - 1473

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 5

ER -