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Study Evaluates Impact of Lymph Node Removal in Early-stage Breast Cancer

Early-stage breast cancer patients without evidence of cancer in their sentinel lymph node who did not have additional lymph nodes removed report fewer side effects to the arm and breast than patients who undergo additional lymph node removal. These findings were recently published in the Journal of Clinical Oncology.[1]

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. A sentinel lymph node biopsy involves the removal of only these nodes. If cancer is found in the sentinel nodes, most women undergo additional lymph node removal. If the sentinel nodes are free of cancer, however, women may not require any additional lymph node removal. Avoidance of extensive lymph node removal reduces the risk of side effects such as lymphedema (swelling).

Several studies have been conducted to determine the efficacy of sentinel lymph node biopsy versus more extensive lymph node surgery. In a recent study presented at the 2010 annual meeting of the American Society of Clinical Oncology, researchers reported that among women with early breast cancer and no evidence of cancer in the sentinel lymph nodes, sentinel lymph node biopsy alone is as effective as more extensive lymph node surgery.[2] In addition to efficacy data, researchers are interested in quantifying how these procedures impact a patient’s quality of life both immediately following surgery as well as months and years later.

In the current substudy of a Phase III trial, researchers evaluated patient-reported data to determine the impact of sentinel node biopsy alone versus sentinel node biopsy plus ALND. The 749 patients in this study had operable, early-stage breast cancer with no clinical evidence of cancer in the lymph nodes. In addition, the patients in this substudy did not have evidence of cancer in the sentinel lymph node. Three-hundred fifty-six had been randomized to undergo sentinel lymph node biopsy plus ALND, and 391 underwent sentinel lymph node biopsy alone. Patients completed a questionnaire before surgery, immediately after surgery, and every six months for approximately three years to assess quality of life, breast symptoms, as well as arm function and symptoms.

  • During the postoperative period, sentinel node biopsy plus ALND was associated with an elevated likelihood of arm and/or breast symptoms, worse quality of life, and more limitations in work and social activity compared with sentinel node biopsy alone.
  • In as little as a year after the procedure, a relatively small percentage of patients in either group reported moderate or severe side effects. 

The researchers concluded that among patients with no evidence of cancer in their sentinel nodes, sentinel node biopsy alone was associated with fewer arm and breast side effects and better quality of life. Over time, however, some of the differences between the groups diminished. 

Reference:



[1] Land SR, Kopec JA, Julian TB, et al. Patient-reported outcomes in sentinel-node negative adjuvant breast cancer patients receiving sentinel-node biopsy or axillary dissection: National Surgical Adjuvant Breast and Bowel Project Phase III Protocol B-32. Journal of Clinical Oncology. [early online publication]. August 2, 2010.

[2] Krag DN, Anderson SJ, Julian TB et al. Primary outcome results of NSABP B-32, a randomized phase III clinical trial to compare sentinel node resection (SNR) to conventional axillary dissection (AD) in clinically node-negative breast cancer patients. Presented at the 2010 annual meeting of the American Society of Clinical Oncology. June 4-8, 2010. Chicago, IL. Abstract LBA 505.