American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

CRP Investigator Webinar: Breast (A11202 and NSABP B-51/RTOG 1304)

A Surgical Investigators Meeting Webinar focusing on Ongoing Breast Cancer Cooperative Group Clinical Trials.

Sponsored by the Alliance for Clinical Trials in Oncology/American College of Surgeons Clinical Research Program.

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Recorded November 22, 2017

Presentation Slides

Moderator: Judy C. Boughey, MD, FACS, Education Committee, ACS CRP 
Speakers: Bruce Haffty, MD, MS; Judy C. Boughey, MD, FACS; Julia White, MD
Trials Covered: A11202 and NSABP B-51/RTOG 1304 (NRG 9353)

A11202

A Randomized Phase III Trial Evaluating the Role of Axillary Lymph Node Dissection in Breast Cancer Patients (cT1-3 N1) Who Have Positive Sentinel Lymph Node Disease After Neoadjuvant Chemotherapy.

This randomized phase III trial compares axillary lymph node dissection and axillary radiation therapy in treating patients with breast cancer treated with preoperative chemotherapy followed by surgery who are found to have positive sentinel lymph node(s). 

To be eligible for this study, patients must meet several criteria, including but not limited to the following:

  • Patients must have had a percutaneous biopsy showing cancer cells in an axillary lymph node before chemotherapy treatment begun.
  • Patients must have stage I-III disease and have completed at least four cycles of chemotherapy before breast cancer surgery.
  • Patients must not have received preoperative radiation therapy or hormonal therapy.
  • Patients must have a clinically negative axilla after chemotherapy.

Schema for ALLIANCE A11202

Schema for ALLIANCE A11202

NSABP B-51/RTOG 1304 (NRG 9353)

A Randomized Phase III Clinical Trial Evaluating the Role of Post-mastectomy Chest Wall and Regional Nodal XRT and Post-lumpectomy Regional Nodal XRT in Patients with Documented Positive Axillary Nodes Before Neoadjuvant Chemotherapy Who Convert to Pathologically Negative Axillary Nodes After Neoadjuvant Chemotherapy

The main purpose of this clinical trial is to study patients with positive nodes before chemotherapy who become lymph node negative after chemotherapy to see (1) if, after lumpectomy, radiation to the breast and lymph nodes will be better than radiation only to the breast at preventing recurrence, and (2) if, after mastectomy, radiation to the area where the breast used to be and to the lymph nodes is better than no radiation. For women with lymph node negative disease, radiation is usually given to the breast only after lumpectomy and not at all after mastectomy. For women with node positive breast cancer, radiation is usually given to the breast and lymph nodes after lumpectomy; and to the chest wall and lymph nodes after mastectomy. Questions remain as to the best approach in patients with positive lymph nodes before chemotherapy who have their nodal disease eradicated by chemotherapy.

Some of the eligibility criteria include:

  • Patients must have a positive lymph node prior to treatment (cT1-3, N1 disease at presentation)
  • Patients must have had a percutaneous biopsy showing cancer cells in an axillary lymph node before chemotherapy treatment begun.
  • Participants must have had at least 8 weeks of standard neoadjuvant chemotherapy.
  • Participants must have had either a lumpectomy or mastectomy.
  • At surgery, all removed axillary nodes must be negative for cancer.

Schema of NSABP B-51/RTOG 1304

Schema of NSABP B-51/RTOG 1304

About the Speakers and Program

More about Bruce Haffty, MD, MS

Bruce G. Haffty, MD, FACR, FASTRO, is Chief of Staff, Rutgers Cancer Institute of New Jersey, Professor and Chairman of Radiation Oncology, Rutgers-Robert Wood Johnson Medical School, New Jersey Medical School and Cancer Institute of New Jersey. His medical school, internship and residency training was at Yale. He spent the majority of his academic career at Yale, where he was Professor of Therapeutic Radiology, residency program director from 1992 through 2004, Vice Chairman and Clinical Director from 2002 to 2005. He moved to Rutgers Cancer Institute of New Jersey in 2005. Dr. Haffty has a long and successful record in clinical and translational research in radiation oncology and is a leader in national clinical trials. 

More about Julia White, MD

Dr. White is a board certified Radiation Oncologist with specific expertise in breast cancer. She currently the Chair of the Radiation Therapy Oncology Group (RTOG) Breast Cancer Committee and principal investigator for RTOG on a Phase III national clinical trial (NSABP B39 / RTOG 0413) enrolling 4300 early stage breast cancer patient.

More about Judy C. Boughey, MD, FACS, Education Committee, ACS CRP 

Judy C. Boughey is professor of surgery and vice chair for research in the Department of Surgery and medical director of clinical research in the Department of Surgery. Dr. Boughey is the program director for the Multidisciplinary Breast Surgery Fellowship at Mayo. She is chair of the Publications Committee for the American Society of Breast Surgeons and Chair of the Education Committee for the American College of Surgeons Clinical Research Program. Dr. Boughey has led multiple national clinical trials funded by National Cancer Institute; ACOSOG Z1071 evaluating SLN surgery in patients with node positive breast cancer treated with neoadjuvant chemotherapy, ACOSOG Z11102 evaluating breast conservation in women with multiple ipsilateral breast tumors and ALLIANCE A11202 comparing axillary dissection to axillary radiation for patients with node positive disease after neoadjuvant chemotherapy. 

More about ALLIANCE/ACS Clinical Research Program

The mission of the ALLIANCE/American College of Surgeons Clinical Research Program (ACS CRP) is to reduce the impact of cancer by increasing knowledge and awareness of new evidence and practice standards; increasing the participation of community oncology surgeons in cancer research and cancer care activities; developing and implementing evidence-based practices in surgical oncology; and creating opportunities for meaningful health services research.