ASCO: RT Alone OK for Some Node-Positive Breast Cancers

cp418

http://www.medpagetoday.com/HematologyOncology/BreastCancer/39560

CHICAGO -- Breast cancer patients with a positive but nonpalpable sentinel lymph node may be better off with radiation than with further axillary surgery, the AMAROS trial affirmed.

Recurrence rates came out similar, at 0.5% with completion axillary lymph node dissection and 1.0% with axillary radiotherapy over 5 years, Emiel Rutgers, MD, of the Netherlands Cancer Institute in Amsterdam, and colleagues found.

Overall survival didn't differ between the groups either, they reported here at the American Society of Clinical Oncology meeting.

But surgery doubled the lymphedema risk compared with radiation alone, at 40% versus 22% at year 1 and 28% versus 14% at year 5 (both P<0.0001).

cp418

http://www.medscape.com/viewarticle/805406

For Node-Positive Breast Cancer, Axillary Radiation Is Best

CHICAGO, Illinois — Radiotherapy is a better option than surgical dissection for women with breast cancer and a positive sentinel lymph node, according to an international multicenter phase 3 trial.

In fact, axillary lymph node dissection (ALND) was associated with twice the rate of lymphedema as axillary radiotherapy, with no better locoregional control and fewer adverse effects, in the European Organization for Research and Treatment of Cancer (EORTC) AMAROS (After Mapping of the Axilla: Radiotherapy or Surgery?) trial.

The results were presented here at the 2013 Annual Meeting of the American Society of Clinical Oncology (ASCO^®).

geewhiz

Wish I could turn back THAT clock! I am still suffering the decision to do axillary clearance. Im glad these new studies turned the tides a bit and will provide better outcomes for sisters coming after us!

cp418

Yes - me too. I had 1+ sentinel node. Sugeon removed total axillary nodes plus had axillary radiation along with left chest rads.  So my heart left side got rads from front and side.

coraleliz

I don't understand where Dr Recht is coming from with this statement

"However, it's much harder for me to justify the potential side effects of radiation (which include rare secondary cancers) and the length of time it takes, compared with ALND, in patients who do not 'need' postmastectomy radiation to prevent a local recurrence. The risk of local failure after mastectomy varies much more, depending largely on the number of nodes involved. Most patients with 1 to 3 positive nodes have a risk of locoregional failure of less than 10% to 15%; at this level, there is only a minimal advantage, if any, for long-term cancer-specific survival from radiation. I have refused to treat patients who have had mastectomy if the only reason is to control disease in the axilla after sentinel node biopsy because of these considerations"

This study had some mastectomy patients in it. 2 yrs ago, my BS would not do an ALND on me even though my MO wanted me to have it done. She believed that RADs would be a better way to go(LE prevention-wise). Don't MX patients like myself(with no recon) just have longer scars? Why not radiate as you would a LX patient. I get the over-radiating/how much do we radiate/how many fields-that part is an unknown & I was probably over treated(radiated). Still, I'm glad I didn't go the ALND route. I didn't want another surgery & another drain when I had healed from my first surgery.......