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 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.