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Complication Rates in Patients With Negative Axillary Nodes 10 Years After Local Breast Radiotherapy After Either Sentinel Lymph Node Dissection or Axillary Clearance

Wernicke, A. Gabriella MD, MSc*; Shamis, Michael MD; Sidhu, Kulbir K. MD; Turner, Bruce C. MD, PhD; Goltser, Yevgenyia BA§; Khan, Imraan BS; Christos, Paul J. PH, MS; Komarnicky-Kocher, Lydia T. MD#

American Journal of Clinical Oncology: February 2013 - Volume 36 - Issue 1 - p 12–19
doi: 10.1097/COC.0b013e3182354bda
Original Articles: Breast

Background: We assess complication rates in node negative breast cancer patients treated with breast radiotherapy (RT) only after sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND).

Materials and Methods: Between 1995 and 2001, 226 women with AJCC stage I-II breast cancer were treated with lumpectomy, either SLND or SLND+ALND, and had available toxicities in follow-up: 111/136 (82%) and 115/129 (89%) in SLND and ALND groups, respectively. RT targeted the breast to median dose of 48.2 Gy (range, 46.0 to 50.4 Gy) without axillary RT. Chi-square tests compared complication rates of 2 groups for axillary web syndrome (AWS), seroma, wound infection, decreased range of motion of the ipsilateral shoulder, paresthesia, and lymphedema.

Results: Median follow-up was 9.9 years (range, 8.3-15.3 y). Median number of nodes assessed was 2 (range, 1-5) in SLND and 18 (range, 7-36) in ALND (P < 0.0001). Acute complications occurred during the first 2 years and were AWS, seroma, and wound infection. Incidences of seroma 5/111 (4.5%) in SLND and 16/115 (13.9%) in ALND (P < 0.02, respectively) and wound infection 3/111 (2.7%) in SLND and 10/115 (8.7%) in ALND (P < 0.05, respectively) differed significantly. AWS was not statistically different between the groups. At 10 years, the only chronic complications decreased were range of motion of the shoulder 46/111 (41.4%) in SLND and 92/115 (80.0%) in ALND (P < 0.0001), paresthesia 12/111 (10.8%) in SLND and 39/115 (33.9%) in ALND (P < 0.0001), and lymphedema assessed by patients 10/111 (10.0%) in SLND and 39/115 (33.9%) in ALND (P < 0.0001). Chronic lymphedema, assessed by clinicians, occurred in 6/111 (5.4%) in SLND and 21/115 (18.3%) in ALND cohorts, respectively (P < 0.0001).

Conclusions: Our mature findings support that in patients with negative axillary nodal status SLND and breast RT provide excellent long-term cure rates while avoiding morbidities associated with ALND or addition of axillary RT field.

*Department of Radiation Oncology

Department of Public Health, Division of Biostatistics and Epidemiology, Weill Cornell Medical College of Cornell University, New York

Department of Biological Sciences, State University of New York, Stony Brook, NY

Department of Medical Sciences, Saint George University, Grenada, WI

Department of Radiation Oncology, Thomas Jefferson University Hospital

#Department of Radiation Oncology, Drexel University Hospital, Philadelphia, PA

§Department of Biological Sciences, Brandeis University, Waltham, MA

Dr Paul Christos was partially supported by the following grant: Clinical Translational Science Center (CTSC) (UL1RR024996).

Preliminary results of this work were presented in an oral plenary session at the American Radium Society (ARS) in 2009 in Vancouver, Canada.

The authors declare no conflicts of interest.

Reprints: A. Gabriella Wernicke, MD, MSc, Department of Radiation Oncology, Weil Medical College of Cornell University, Stich Radiation Oncology, 525 East 68th Street, New York, NY 10065. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc