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June 8, 2011

Axillary vs Sentinel Lymph Node Dissection for Invasive Breast Cancer

JAMA. 2011;305(22):2288-2291. doi:10.1001/jama.2011.751

To the Editor: No differences in locoregional recurrence, disease-free survival (DFS), or overall survival (OS) rates were found in women with invasive breast cancer receiving SLND alone vs ALND.1 However, differences in time of initiation of adjuvant chemotherapy might have affected the outcomes. The International Breast Cancer Study Group published a retrospective analysis of the timing of adjuvant chemotherapy from 3 prospective trials. The 10-year DFS rate was 51% in those commencing adjuvant chemotherapy within 21 days of surgery and 42% in those starting after 21 days (hazard ratio [HR], 0.83; P = .0095).2 Similarly, Lohrisch et al3 conducted a retrospective analysis of 2594 patients receiving adjuvant chemotherapy; the recurrence-free survival (RFS) and OS were compromised if adjuvant chemotherapy was initiated 12 or more weeks after surgery. In this study,1 SLND alone would likely result in an earlier start of adjuvant chemotherapy than would ALND, and this might lead to better survival.