![]() ![]() However, the cancer research community had lingering concerns about the trial, the authors of the new paper explained.įor example, the trial recruited fewer participants than initially planned. These early results “were absolutely practice changing, and at this point the overwhelming majority of surgeons are not doing a full axillary lymph node dissection in patients with one or two positive nodes,” said Larissa Korde, M.D., head of Breast Cancer Therapeutics in NCI’s Division of Cancer Treatment and Diagnosis. The two groups also had similar rates of disease-free survival and cancer recurrence in the lymph nodes. In the initial results from the trial, published in 20, women who had only SLNB did not have worse overall survival than women who underwent full ALND. Almost 90% of women in both groups had radiation therapy after surgery, and almost all received some type of systemic therapy. Half of the trial participants received no further surgery, and the other half underwent ALND. All women had undergone SLNB at the time of breast-conserving surgery. Women who had stage I or II cancer and metastases in only one or two sentinel nodes were eligible to join the study. The research team enrolled 891 participants into the study from 1999 to 2004. The trial, called ACOSOG Z0011, was designed to compare whether sentinel lymph node biopsy (SLNB) alone provided equivalent survival benefits to ALND after breast-conserving surgery among a subset of women who also received radiation and systemic therapy. Less Lymph Node Surgery, Equivalent Survival Most patients additionally receive some sort of systemic treatment, such as hormone therapy, chemotherapy, and, more recently, targeted therapy, all of which can kill cancer cells throughout the body. Giuliano.Īlso, modern treatment for early-stage breast cancer typically includes radiation therapy-which targets some of the same lymph nodes-along with breast-conserving surgery, Dr. However, more-recent research has suggested that breast cancer may metastasize to other areas of the body through several different routes, explained Dr. That led doctors to believe that removing the axillary lymph nodes could reduce the risk of both cancer recurrence and metastases. Early theories of breast-cancer metastasis held that cancer cells that had broken free from the main tumor would first travel through these lymph nodes on their way to other organs. The axillary lymph nodes run from the breast tissue into the armpit. Changing Views on Breast Cancer Metastasis The trial results were published September 12 in JAMA. Giuliano said he now feels comfortable telling patients that, in the long term, they would “suffer more from the axillary dissection than from the omission of the axillary dissection.” The findings are important for patients because ALND can cause chronic side effects such as numbness, decreased range of motion in the upper body, and lymphedema, said Armando Giuliano, M.D., of Cedars-Sinai Medical Center in Los Angeles, who led the trial.ĭr. The trial showed that women with early-stage breast cancer who have cancer cells in one or two sentinel lymph nodes can skip axillary lymph node dissection (ALND) after breast-conserving surgery without affecting their long-term survival. ![]() Long-term results from a large clinical trial confirm that, for some women with early-stage breast cancer who have lumpectomy as their surgical treatment, a less extensive lymph node biopsy approach is sufficient.
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