Management of the axilla in operable breast cancer treated by breast conservation: a randomized clinical trial

Chetty, U.; Jack, W; Prescott, R. J.; Tyler, Christine; Rodger, Alan

doi:10.1046/j.1365-2168.2000.01345.x

Cited by 124 publications

(50 citation statements)

References 24 publications

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“…Lower rates of complications have been reported with SLNB or lymph node sampling plus radiotherapy compared with full dissections performed in breast cancer patients. 43,44 Radiotherapy is not without its toxicities such as tissue fibrosis, brachial plexopathy, and lymphedema; however, long-term toxicity rates are expected to be low, particularly with doses of 50 to 55 Gy. Daily radiation treatment for 5 to 6 weeks is an inconvenience to the patient compared with surgery, although this may be an acceptable alternative if the risk of late toxicities are lowered.…”

Section: Discussionmentioning

confidence: 99%

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Fang

Lemos

Douglas

et al. 2010

Cancer

145

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BACKGROUND:Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high risk of lymph node involvement. To the authors' knowledge, few data have been published to date regarding the optimal regional therapy for lymph node‐positive patients. This cohort study was performed to analyze the outcomes of patients with lymph node‐positive MCC treated with lymph node irradiation as definitive therapy compared with completion lymphadenectomy (CLND).METHODS:Fifty patients with lymph node involvement of MCC at presentation and adequate follow‐up data were included in this analysis. Forty‐three of these patients were enrolled and followed prospectively. Twenty‐six patients presented with microscopic lymph node disease, and 24 patients presented with palpable lymph node involvement.RESULTS:Regional control for patients with microscopically involved lymph nodes was 100% regardless of treatment modality—definitive lymph node irradiation (n = 19) or CLND ± radiotherapy (n = 7) with median follow‐up of 18 months. Patients with clinically positive lymph nodes had 2‐year regional recurrence‐free survival rate of 78% and 73% in the definitive lymph node irradiation (n = 9) and CLND ± radiotherapy (n = 15) groups, respectively (P = .8) with a median follow‐up of 16 months.CONCLUSIONS:To the best of the authors' knowledge, the current study is the largest series published to date of radiation monotherapy as regional treatment for lymph node‐positive MCC. Lymph node irradiation alone to positive regional lymph nodes was found to confer an excellent regional control rate that was comparable to CLND for both microscopic and palpable lymph node disease. There was no difference noted with regard to overall survival. Given their similar efficacy, the choice between these lymph node therapies may be based on the clinical scenario and anticipated side effect profiles. Cancer 2010. © 2010 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Fang

Lemos

Douglas

et al. 2010

Cancer

145

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“…Patients who are node-negative after axillary sampling can thus avoid axillary radiotherapy or axillary clearance. 11 Pain, numbness, a tingling or a burning sensation in the (upper) arm region are likely to result from transsection of one or more branches of the intercostobrachial nerves during the axillary surgical procedure. Radiation therapy can contribute to these complaints by direct damage to the nerve or by post-irradiative inflammatory response, leading to scar tissue formation and fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy

Schijven¹,

Vingerhoets²,

Rutten³

et al. 2003

European Journal of Surgical Oncology (EJSO)

255

125

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Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy Schijven, M.; Vingerhoets, Ad; Rutten, H.J.T.; Nieuwenhuijzen, G.A.P.; Roumen, R.M.H.; Bussel, M.E.; Voogd, A.C. General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.-Users may download and print one copy of any publication from the public portal for the purpose of private study or research -You may not further distribute the material or use it for any profit-making activity or commercial gain -You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright, please contact us providing details, and we will remove access to the work immediately and investigate your claim.Download date: 12. mei. 2018 EJSO 2003; 29: 341±350 doi:10.1053/ejso.2002.1385 Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy Aims: The use of axillary lymph node dissection (ALND) in women with breast cancer is associated with considerable morbidity. Sentinel node biopsy (SNB) removes the lymph node in the axillary basin indicative for receiving first lymphatic drainage from the breast. This study compares the nature and severity of physical morbidity among breast cancer patients who underwent primary surgery for breast cancer combined with either ALND or SNB. Also, it assesses influence of subsequent radiotherapy on morbidity. Method: Two hundred and thirteen ALND patients were compared with 180 SNB patients retrospectively. Morbidity was measured using a disease-specific quality-of-life questionnaire. Results: Patients' demographic characteristics were alike. The axillary procedure is the strongest and most consistent factor in explaining differences in a variety of self-reported complaints. Patients having had SNB have a 3.2-fold lower risk of experiencing pain, a 5-fold lower risk of lymph oedema, a 7.7-fold lower risk of numbness, a 3.7-fold lower risk of tingling sensations, a 7.1-fold lower risk of loss of strength in arm/hand, a 3.6-fold lower risk of loss of active motion range of the arm and a 2.9-fold lower risk of impaired use of the arm. Axillary radiation therapy adds to complaints next to the axillary surgical procedure by increasing the risk of lymph oedema 2.4-fold and enhancing the risk of impaired use of the arm by 2.6-fold. Axillary radiation therapy does not explain lymph oedema by itself. Conclusion: SNB is associated with less morbidity compared to ALND in patients with primary breast cancer.

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“…Randomized trials that have directly compared limited axillary dissection or sampling with more extensive dissection yielded similar rates of nodal status distribution (14)(15)(16)(17)(18) and similar survival or mortality between the two arms (14,17,18). These trials showed comparable efficiency of limited axillary exploration, with a condition highlighted by Steele et al: '... it is important to emphasize that it is the surgeon who must take the responsibility for identifying nodes and in our unit a satisfactory sampling procedure now requires the identification of four nodes fixed for histology by the operating surgeon' (15).…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

Effect of the number of uninvolved nodes on survival in early breast cancer

Vinh‐Hung¹,

Cserni²,

Burzykowski³

et al. 2003

Oncol Rep

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Abstract.A high number of uninvolved axillary nodes was found by some authors to be associated with poor survival in node-negative breast cancer. We searched for confirmation and extend the investigation to node-positive cases, using population data from the SEER Program. Patients selected were women aged 40-69 years, diagnosed 1988-1997, T1-T2 breast cancer, undergoing axillary dissection with 4-35 nodes examined. Survivals were estimated by the product-limit method and were computed on pooled data. Results in nodenegative patients (n=37,519) showed a 5-year overall survival from 92% (95% confidence interval: 88-95%) with 4 uninvolved nodes, to 93% (87-98%) with 34 uninvolved nodes. In node-positive patients (n=16,978), the 5-year survival increased from 50% (44-56%) with 0 uninvolved nodes, to 91% (82-100%) with 30 uninvolved nodes. Survival graphs indicated an improvement or a plateau with higher number of uninvolved nodes. The graphs also suggested that the ratio of involved and uninvolved nodes might be correlated with survival. We conclude that there was no evidence of poor outcome associated with a high number of uninvolved nodes. The incidental finding that ratio-based characterization of node involvement might be a prognostic factor will be further investigated. IntroductionTumor draining lymph nodes can undergo hyperplasia, resulting in increases in the number and size of detectable lymph nodes. A high number of tumor free axillary lymph nodes might thus represent the effect of lymphangiogenic and lymph node development factors playing a role in tumor metastasis (1). In support of that hypothesis, Camp et al reported that axillary dissection yielding more than 20 nodes in node-negative breast cancer was associated with a poor survival (1) when compared with node-negative breast cancer patients having less than 20 nodes examined.The Surveillance, Epidemiology, and End Results (SEER) provides detailed data on nodal extent for cases diagnosed since 1988 (2). The objective of the present study is to examine the pattern of survival, whether or not there is supportive evidence in the SEER registries data that high numbers of uninvolved nodes (nneg) are indicators of poor outcome.If lymphogenic factors are involved in node-negative (N0) breast cancer, then it should be expected that these factors are also involved in node-positive (N + ) cases. Therefore, consistency requires that the role of nneg should be examined in both N0 and N + cases, taking into account the number of positive nodes (npos).Outline of this study and results of a multivariate analysis by proportional hazard models have been reported previously (3). The mortality hazard ratio associated with the number of uninvolved nodes was 0.990 (95% confidence interval: 0.983-0.996) in N0, and 0.970 (0.963-0.976) in N + , i.e. 1% risk reduction and 3% risk reduction per uninvolved node, respectively. These results argued against the role of uninvolved nodes as indicators of poor prognosis. The present report will focus on the visual display of data. W...

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Management of the axilla in operable breast cancer treated by breast conservation: a randomized clinical trial

Abstract: A selective policy for the management of the axilla is associated with no increase in axillary recurrence or mortality rate compared with routine axillary node clearance. Patients who are node negative after axillary sample can avoid radiotherapy or axillary clearance.

Cited by 124 publications

References 24 publications

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy

Effect of the number of uninvolved nodes on survival in early breast cancer

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