Axillary vs Sentinel Lymph Node Dissection for Invasive Breast Cancer

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.