Axillary dissection in women with sentinel node metastasis

We thank Dr. Dixon for his interest in our editorial. The ACOSOG
Z0011 trial enrolled women with sentinel node metastasis, so our comments
regarding the necessity of axillary lymph node dissection for certain
subgroups were not meant to apply to women with a negative sentinel lymph
node biopsy. With regard to the use of adjuvant chemotherapy, Dr. Dixon
correctly points out that the AMAROS trial demonstrated that
administration of chemotherapy was similar between those who received
axillary dissection and those who received sentinel lymph node biopsy and
axillary radiotherapy. However, the number of involved nodes still remains
the most important factor in determining prognosis and the absolute
benefit of chemotherapy. There may be individual women, for example those
who wish to avoid chemotherapy or who have significant comorbidities,
where the risk-benefit ratio of chemotherapy may be important to them in
deciding whether to accept the therapy. Dr. Dixon also stated that a
surgeon should have been an author. Co-author Deborah Axelrod, M.D. is
Associate Professor of Surgery at New York University School of Medicine.