Lymph node removal


Lymph node removal may not always be needed for breast cancer patients, Houston study says

Study changes care for breast cancer
Lymph-node removal isn’t necessary for many patients

Women with early-stage breast cancer don’t need surgery to remove malignant lymph nodes from the armpits, according to a new study finding that could spare tens of thousands of women a year from the complication-laden procedure.

The study, conducted at the University of Texas M.D. Anderson Cancer Center and more than 100 other sites, found that taking out cancerous lymph nodes in that subset of women provided no benefit over radiation and drug treatment alone, a repudiation of the time-honored belief that node removal prevents recurrence.

“This is a practice-changing finding, a case that proves the adage that less is more,” said Dr. Kelly Hunt, a professor of surgery at M.D. Anderson and the study’s second author. “It shows that we don’t have to take out huge swaths of tissue, that we can avoid aggressive surgery without any effect on outcome.”

M.D. Anderson enrolled the most patients of any institution in the study, nearly 100 of 891. Researchers originally planned for about 1,900 patients, but stopped early because the results were already conclusive.

Hunt said M.D. Anderson has already changed its practice to incorporate the study findings, which were reported in the Journal of the American Medical Association Tuesday.

Dr. Kent Osborne, director of Baylor College of Medicine’s Breast Center, said his center also is changing its practice and not removing lymph nodes among women with early-stage breast cancer.

Nearly 200,000 women a year are diagnosed with invasive breast cancer and Hunt said as many as 60,000 have the sort of limited lymph node spread the study showed doesn’t require surgical removal.

Other patients still need the procedure, she said, at least until future studies show otherwise. One such study is ongoing.

The nodes’ removal can lead to such complications as infection and an often very disabling condition called lymphedema, a swelling in the arm. Hunt called it a major quality of life issue for breast cancer survivors and said women already aware of the condition when initially diagnosed fear it.

Study adds to a trend

The study findings continue a pattern away from aggressive surgery in breast cancer care. Previously, researchers showed survival rates were just as good after lumpectomy, the surgical removal of the part of the breast with the tumor, as they were when the patient had a mastectomy, the removal of the whole breast.

But surgeons have continued to remove most or all of the lymph nodes when cancer cells have spread to the so-called sentinel node, the one closest to the cancer.

The American Society of Surgical Oncology recommends aggressive node surgery, for example, even when the cancer has spread to just one or two nodes, one of the hallmarks of Stage II cancer.

Women in mid-50s

The study involved women with a median age in the mid-50s who’d undergone a lumpectomy to remove their tumor and had cancerous activity in one or two nodes.

Half were randomly selected to have radiation and at least 10 nodes removed and the other half received radiation and either chemotherapy or hormone-blocking treatment but no further surgery.

Five years after treatment, 92 percent of the women in both groups were still alive. Eighty-two percent of the women who had their nodes removed were cancer-free, compared with 84 percent of those who didn’t, a difference researchers said was not statistically significant.

By a nearly 3-to-1 margin, women who had nodes taken out were much more likely to have complications such as infections and fluid in the armpit.

Patients whose cancerous lymph nodes would still require surgery are those with Stage 3 cancer; those who had a mastectomy and did not receive radiation; or those who had chemotherapy before surgery, a sign the cancer may be more resistant and might not be killed by radiation.

Osborne, recalling a study that hinted at similar findings back in the 1970s, said the new study was no surprise to him. He said it foreshadows a day when surgery may not be necessary for breast cancer.


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