Additional Lymph Node Removal May Not Be Necessary for Some Cancer Patients
Among women with early-stage breast cancer and small amounts of cancer in the sentinel lymph node(s), removal of additional lymph nodes (axillary lymph node dissection) does not appear to improve overall survival. The results of this study were published in the Journal of the American Medical Association.
For women with early breast cancer, determining whether the cancer has spread to the axillary (under the arm) lymph nodes is an important part of cancer staging. Evaluation of the axillary nodes may involve either an axillary lymph node dissection (ALND), in which many lymph nodes are surgically removed and evaluated, or a less extensive procedure known as a sentinel lymph node biopsy.
The sentinel nodes are the first lymph nodes to which cancer is likely to spread. If the sentinel nodes are free of cancer, no further lymph node evaluation is performed. If the sentinel nodes contain cancer, however, many women then undergo ALND to remove additional nodes. This additional lymph node surgery may help control cancer locally, but the effect on survival has been controversial. Establishing the benefits of ALND is important because it can cause significant side effects such as pain, discomfort, and swelling (lymphedema).
To evaluate the effects of ALND, researchers conducted a study among 891 women with early breast cancer and small amounts of cancer in the sentinel lymph node(s). Half the women underwent ALND and half did not. In addition, all of the women were treated with lumpectomy and radiation therapy, and most received adjuvant (post-surgery) chemotherapy and/or hormonal therapy.
- The median number of lymph nodes removed was 17 in the ALND group and two in the group that did not undergo ALND.
- Five-year overall survival was 91.8% among women who underwent ALND and 92.5% among women who did not undergo ALND.
- Disease-free survival was 82.2% among women who underwent ALND and 83.9% among women who did not undergo ALND.
- Side effects such as wound infections and swelling were more common in the ALND group.
These results suggest that for women with early-stage breast cancer and small amounts of cancer in the sentinel lymph nodes, additional lymph node surgery may not be necessary.
The researchers conclude that for selected patients, avoidance of completion ALND “would improve clinical outcomes in thousands of women each year by reducing the complications associated with ALND and improving quality of life with no diminution in survival.”
Reference: Giuliano AE, Hunt KK, Ballman KV et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: A randomized clinical trial. JAMA. 2011;305:569-575.
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