乳腺癌前哨淋巴结与放疗.ppt

《乳腺癌前哨淋巴结与放疗.ppt》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、乳腺癌前哨淋巴结与放疗保乳手术breastconservativetreatment(BCT)safe-resultsofrandomizedtrialsinthe1980’spatientswithearlybreastcancer前哨淋巴结活检ahighlevelaccuracyfalsenegativeratearound7%equivalentoncologicaloutcomesintermsofdistantdisease-freeandoverallsurvivalsurprisinglylowregionalrec

2、urrencerateoflessthan1%前哨淋巴结活检negativeSN---completionALNDisnotrequired前哨淋巴结活检axillarymetastasisarelimitedtheSNin60-70%overall90%forlowvolumeinvolvement(micrometastasis/isolatedtumourcellsdetectedbyimmunohistochemicalstainingonly)前哨淋巴结活检patientswithinvolvedSNomitthecom

3、pletionALNDnoapparentdetrimenttooncologicaloutcomesACOSOG-Z0011AmericanCollegeofSurgeonsOncologyGroup(ACOSOG)-Z0011axillarydissectionvs.noaxillarydissectionACOSOG-Z0011May1999-Dec2004115sitesACOSOG-Z0011Eligibilitycriteriaolderthan18years,T1-2invasivebreastcancer,nopa

4、lpableaxillaryadenopathy,and1or2SNmetastasiswithoutextranodalextensionACOSOG-Z0011ExclusioncriteriaClinicallynodepositivediseasemorethan2positivesentinelnodes,mattednodes,grossextranodaldiseasePreoperativesystemictreatmentsisolatedtumourcells(ITC)intheSNACOSOG-Z0011St

5、ratificationage(youngerorolderthan50years)ERstatustumoursize(<1cm,1-2cm,>2cm)ACOSOG-Z0011BCSandSNBSNmetastasisin1or2nodesrandomlyassignedALNDornofurtheraxillaryALNDadissectionofatleast10lymphWBISystemicadjuvanttherapyACOSOG-Z0011ThemainoutcomemeasureoverallsurvivalSec

6、ondaryoutcomemeasurediseasefreesurvivalACOSOG-Z0011noninferioritytrialtheSNB-onlygrouphavinga5-yearOSnotlessthan75%ofALNDgroupTargetedenrolmentwas1900womenwithafinalanalysisafter500deaths.ACOSOG-Z0011Thetrialwasclosed891patientsduetolowerthanexpectedaccrualandeventrat

7、esACOSOG-Z0011445ALND446SNbiopsyalone35patients(25ontheALNDarmand10ontheSNBarm)excludedbecausewithdrewconsentACOSOG-Z0011ACOSOG-Z0011ACOSOG-Z0011ACOSOG-Z0011ACOSOG-Z0011ACOSOG-Z0011ACOSOG-Z0011limitedSNmetastaticbreastcancerBreastconservationandsystemictherapy,SNBalon

8、ecomparedwithALNDdidnotresultininferiorsurvivalACOSOG-Z0011Potentialproblemsstatisticaldesignandinterpretationenrolmentofpat