In the News
Some patients with early-stage breast cancer may be able to safely forego full axillary lymph node dissection, reducing their risk of adverse effects, according to new research. The American College of Surgeons Oncology Group Z0011 trial enrolled women with histologically confirmed early-stage invasive breast cancer (tumors of 5 cm or smaller), no palpable adenopathy, and one or two sentinel lymph nodes containing cancer cells. Patients underwent sentinel lymph node dissection and were then randomized to undergo dissection of the remaining axillary nodes (n = 445) or to receive no further axillary intervention (n = 446). All patients underwent lumpectomy and tangential whole-breast radiation. Adjuvant therapy was at the discretion of the treating physician.
At a median follow-up of 6.3 years, overall survival, the primary end point, was not statistically inferior in the group undergoing only sentinel node dissection, compared with the group undergoing full dissection: 92.5% and 91.8% at five years, respectively. Five-year disease-free survival was also similar in the two groups (83.9% and 82.2%, respectively), as was locoregional recurrence at five years (1.6% and 3.1%). Not surprisingly, women in the full-dissection group experienced more lymphedema and other surgical morbidities, including wound infections, axillary seromas, and paresthesias.
The results suggest that complete axillary lymph node dissection may "no longer be justified" in women with one or two positive sentinel nodes and a tumor of 5 cm or smaller (T1 or T2) treated with lumpectomy, radiation, and adjuvant therapy, the study authors write. This could reduce complications and improve quality of life.
Mei R. Fu, assistant professor at the New York University College of Nursing and author of AJN's two-part article on post-breast cancer lymphedema (July and August 2009), agreed. "Sparing this group of patients from full axillary lymph node dissection may reduce their risk of developing long-term and later adverse effects, including impaired limb mobility, lymphedema, chronic pain, and neurologic symptoms," she said. Nurses should help patients determine whether they have the type of breast cancer that would allow them to consider removal of fewer lymph nodes, said Fu, adding that nurses should "advise them to balance the risks and benefits in making a treatment choice, whether it's full lymph node dissection or removal of fewer lymph nodes." She also noted that although removal of fewer lymph nodes reduces the risk of later adverse effects, it doesn't eliminate it. "New technology, such as infrared perometry and symptom assessment, may enable early detection of later adverse effects."—Karen Rosenberg
Giuliano AE, et al. JAMA 2011;305(6):569-75.