Changing behavior in clinical practice in response to the ACOSOG Z0011 trial: A survey of the American Society of Breast Surgeons

Background. The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in overall survival or local-regional recurrence rates between patients planned for breast conservation therapy including whole breast irradiation (WBI) with one or two positive sentinel lymph nodes (SLNs) randomly selected to undergo axillary lymph node dissection (ALND) versus no further surgery. The current study was undertaken to evaluate the impact of Z0011 on surgical practice nationally. Methods. A survey was sent by e-mail to 2,759 members of the American Society of Breast Surgeons (ASBrS). Questions assessed the respondents' practice, familiarity with Z0011, and preferences for treating patients with one or two positive SLNs. Results. Of those surveyed, 849 (30.8 %) responded. The majority (97 %) indicated familiarity with the data. Of those respondents, 468 (56.9 %) would not routinely perform ALND in patients planned to receive WBI, while 279 (36.0 %) would consider omission of completion ALND in patients planned to receive accelerated partial breast irradiation (APBI), and 218 (26.6 %) would consider omission of ALND in patients not planned to receive radiation. Academic and private practice surgeons were equally likely to incorporate Z0011 into practice. Conclusions. ACOSOG Z0011 has changed surgical practice. ASBrS respondents have embraced Z0011 and have changed their practice, omitting ALND in patients with one or two positive SLNs who will undergo WBI. However, many also omit ALND in patients undergoing surgery without radiation or with APBI. As these clinical scenarios were not studied in Z0011, further evaluation is required prior to changing clinical practice.