Fewer early stage breast cancer patients may need lymph node removal: study

December 6, 2018

(HealthDay)—For many breast cancer patients, removal of lymph nodes in the armpit area is a common procedure, due to worries that the tumor has spread to these tissues.

But the operation can also bring the difficult long-term side effect of lymphedema, a painful arm swelling.

Now, new Dutch research suggests that for early stage , radiating the lymph nodes may bring about as good a chance of long-term survival as full removal—perhaps sparing women those tough side effects.

The new 10-year study finds that both lymph node removal or treatments "provide excellent and comparable overall survival," said study co-author Dr. Mila Donker, a at the Netherlands Cancer Institute. Her team was scheduled to present the new findings Thursday at the annual San Antonio Breast Cancer Symposium.

All things being equal, many women may now opt for radiation only and spare themselves lymphedema, said one U.S. oncologist.

"If, in fact, the rate of recurrence in the or armpit is basically the same with radiation as compared to removal of lymph glands, this would make radiation very interesting as an alternative," said Dr. Lauren Cassell, who wasn't involved in the new study. She directs breast surgery at Lenox Hill Hospital in New York City.

The new research involved 1,425 women with early stage breast cancer that had spread to their armpit lymph nodes and was found by biopsy. Each patient was randomly assigned to have either surgery (744 women) or (681 women).

After 10 years, recurrence of cancer in the armpit lymph nodes had occurred in 1.82 percent (11 out 681 patients) of those who had received radiation therapy and 0.93 percent (7 out of 744 patients) of those who had undergone surgery.

Overall survival rates after 10 years were 81.4 percent for the radiation patients and 84.6 percent of those who'd had lymph nodes removed, Donker's team found.

Dr. Emiel Rutgers, a surgical oncologist at the Netherlands Cancer Institute in Amsterdam, was the lead investigator of the new study. "Patients with early stage invasive breast cancer who have no clinical evidence of local spread of disease to axillary (armpit) lymph nodes, meaning that palpation or ultrasound shows no sign of disease spread, undergo a ," he explained in a meeting news release.

However, "data from another recent clinical trial suggested that there may be some patients who do not need axillary treatment even if they have a positive sentinel lymph node biopsy," Rutgers added.

The new study seems to reinforce that view, at least for some patients, he said.

"Moving forward, we need to better tailor treatment for each individual patient. Some will still need axillary treatment, and our data indicate that axillary radiotherapy is a good option here," Rutgers concluded.

One other U.S. expert was encouraged by the new findings.

"As breast surgeons, many of us have been excited about and eagerly anticipating the results," said Dr. Alice Police, regional director of at Northwell Health Cancer Institute in Sleepy Hollow, N.Y.

The notion that some patients can avoid lymph removal "is very appealing as a surgeon and as a human being," she said. Police noted that in recent years, removal of just one or two so-called "sentinel" has become routine. Surgeons use these sample nodes to assess if (and by how much) breast cancer may have spread, before deciding on whether to remove more nodes.

Already, the number of full lymph-removal surgeries has been reduced by using this sentinel node approach, she said.

And with the results of the new Dutch trial, "we now know that even with one positive lymph node, more patients can have radiation therapy instead of more surgery," Police said.

"Radiation therapy has fewer complications and is generally easier on patients," she said. "This is wonderful news for breast patients who can rest assured that radiation instead of more surgery will not increase their mortality rates or recurrence rates with only a small amount of [lymph node] disease. I am happy that for some we can make this an easier journey."

Because the new findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal.

Explore further: Which breast cancer patients need lymph nodes removed? Ultrasound narrows it down

More information: Lauren Cassell, M.D., chief of breast surgery, Lenox Hill Hospital, New York City; Alice Police, M.D., Westchester regional director of breast surgery, Northwell Health Cancer Institute, Sleepy Hollow, N.Y.;
2018 San Antonio Breast Cancer Symposium, news release, Dec. 6, 2018

The American Cancer Society has more on lymph nodes and cancer.

Related Stories

Which breast cancer patients need lymph nodes removed? Ultrasound narrows it down

February 2, 2015
Which breast cancer patients need to have underarm lymph nodes removed? Mayo Clinic-led research is narrowing it down. A new study finds that not all women with lymph node-positive breast cancer treated with chemotherapy ...

Less invasive surgery detects residual breast cancer in lymph nodes after chemotherapy

December 5, 2012
Most patients whose breast cancer has spread to their lymph nodes have most of the lymph nodes in their armpit area removed after chemotherapy to see if any cancer remains. A study conducted through the American College of ...

Some breast cancer patients on neoadjuvant chemo may avoid axillary lymph node dissection

December 7, 2016
A sentinel lymph node biopsy (SLNB) during surgery that showed no signs of cancer was associated with a low risk for breast cancer recurrence in the axillary (armpit) lymph nodes for patients with large, operable breast tumors ...

Study examines accuracy of test for lymph node metastases in women with breast cancer

April 16, 2018
For patients diagnosed with breast cancer, determining whether cancer cells have spread to the axillary lymph nodes of the armpit is important for guiding treatment decisions. It has been debated whether axillary ultrasound ...

Breast cancer update: Sentinel node biopsy guidelines encourage 'less is more' approach

December 12, 2016
New recommendations from breast cancer experts on sentinel lymph node biopsy reinforce the most recent "less-is-more" guidelines for early-stage disease. But a Fred Hutch researcher who helped create the guidelines said many ...

Less can be more when removing lymph nodes during breast cancer surgery

October 1, 2013
A conservative approach to removing lymph nodes is associated with less harm for breast cancer patients and often yields the same results as more radical procedures, researchers at UT Southwestern Medical Center have found.

Recommended for you

Immunotherapy combo not approved for advanced kidney cancer patients on the NHS

December 14, 2018
People with a certain type of advanced kidney cancer will not be able to have a combination of two immunotherapy drugs on the NHS in England.

New drug seeks receptors in sarcoma cells, attacks tumors in animal trials

December 13, 2018
A new compound that targets a receptor within sarcoma cancer cells shrank tumors and hampered their ability to spread in mice and pigs, a study from researchers at the University of Illinois reports.

Surgery unnecessary for many prostate cancer patients

December 13, 2018
Otherwise healthy men with advanced prostate cancer may benefit greatly from surgery, but many with this diagnosis have no need for it. These conclusions were reached by researchers after following a large group of Scandinavian ...

Combining three treatment strategies may significantly improve melanoma treatment

December 12, 2018
A study by a team led by a Massachusetts General Hospital (MGH) investigator finds evidence that combining three advanced treatment strategies for malignant melanoma—molecular targeted therapy, immune checkpoint blockade ...

Researchers use computer model to predict prostate cancer progression

December 12, 2018
An international team of cancer researchers from Denmark and Germany have used cancer patient data to develop a computer model that can predict the progression of prostate cancer. The model is currently being implemented ...

New insight into stem cell behaviour highlights therapeutic target for cancer treatment

December 12, 2018
Research led by the University of Plymouth and Technische Universität Dresden has identified a new therapeutic target for cancer treatment and tissue regeneration – a protein called Prominin-1.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.