ASBS: Radiotherapy Preferred for Node-Positive Breast Cancer
Morbidity up with axillary lymph node dissection versus axillary radiotherapy
THURSDAY, May 1, 2014 (HealthDay News) -- For patients with breast cancer with a positive sentinel node (SN), treatment with axillary lymph node dissection (ALND) is associated with more morbidity than axillary radiotherapy (ART), according to a study presented at the annual meeting of the American Society of Breast Surgeons, held from April 30 to May 4 in Las Vegas.
Mila Donker, M.D., from the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital in Amsterdam, and colleagues enrolled 4,806 breast cancer patients with a positive SN who received axillary treatment between 2001 and 2010. Lymphedema and shoulder mobility were assessed at one and five years follow-up, based on treatment received (ART, 406 patients; ALND, 387 patients, ALND+ART, 27 patients).
The researchers found that surgical complications occurred in 23 and 9 percent of patients in the ALND and ART groups, respectively (P < 0.001). Paresthesia of the arm was seen in 10 and 9 percent of patients, respectively. At one year post treatment, lymphedema was seen in 15 percent of ART-treated patients, 25 percent of ALND-treated patients, and 59 percent of ALND+ART-treated patients (both P < 0.001 versus ART). These rates were 10, 21, and 58 percent, respectively, after five years (both P < 0.001 versus ART). Treatment with ALND versus ART (odds ratio, 2.2) or ALND+ART versus ART (odds ratio, 7.6), body mass index above 25 kg/mN, premenopausal status, and treatment on the dominant side were independent risk factors for the development of lymphedema within the first year.
"These are extremely important findings that may change surgical guidelines and offer better quality of life for many, many women. This is particularly true for younger patients, who would otherwise live with the difficult side effects of node surgery, such as lymphedema, for a long time," Donker said in a statement. "I believe that as a result of this trial, radiotherapy of the nodes will begin to replace surgery. The results are that definitive and significant for patients' quality of life."