LE risk for ALND vs Rads

Get an opinion of a RO

My MO wanted me to have an ALND.

My BS wouldn't do it. She thought the risk for LE would be 25-30% with an ALND. I guess I would have had to find another BS to go this route

Initially my RO told me that I should have an ALND if my MO thought it would give him useful information in order to treat me. Then he called me about a week later & said he reviewed some studies & believed RADs were a better alternative for me. The risk of LE with RADs would be around 5%. He said from a "quality of life standpoint" that was what he recommended.

My story's different , I narrowly dodged chemo. Hopefully someone with a closer diagnosis to yours will chime in soon. Wish you well with decision making & treatments.

Here's a discussion that is based on a variety of studies, and the one by Shah and Vicini is actually a very well done study-of-studies. You can see from this discussion just how far apart the LE incidence ranges are, depending on nature of the studies. LE studies tend to have lots of warts that make it difficult to compare study results; for example, the diagnostic criteria are not standard, and neither is the patient follow-up period after surgery or completion of BC treatments. That explains the wide, wide risk ranges noted in the Shah and Vicini review.

Breast cancer treatments and Breast Cancer-Related Lymphedema (BCRL) risk

BCRL risk factors seem to be additive: A woman with breast conserving surgery and no other treatment has less BCRL risk than a woman receiving breast conserving surgery with axillary node dissection and radiation. Increasing the number of nodes removed also increases BCRL risk (Paskett et al)[i]. Sentinel node biopsy, which removes one to seven nodes, brings a lower risk than axillary node dissection, when 25 or more nodes might be removed.

Shah and Vicini (2011) summarized lymphedema incidence ranges with various treatments, in their BCRL-study review: [ii]

Lumpectomy alone 0-3%

Lumpectomy with SLN and breast radiation therapy (RT) 3-23%

Lumpectomy with axillary lymph node dissection (ALND) and breast RT 1-61%

Lumpectomy with regional nodal RT 9-65%

Mastectomy with SLN, no RT 3-23%

Mastectomy with ALND, no RT 30-47%

Mastectomy with regional nodal RT 58-65%

ALND with axillary RT 32%

ALND = axillary node dissection SLN=sentinel node RT=radiation therapy

Most BCRL studies focus on arm lymphedema, which is readily measured once past Stage 0, or subclinical BCRL. However, many breast cancer patients develop lymphedema of the breast or trunk, with or without arm lymphedema. One year after surgery, Ronka et al (2004) found breast edema identified by clinical examination in 48% of patients with axillary clearance/ positive nodes; in 35% with axillary clearance/ negative nodes; and in 23% with sentinel node biopsy. Using ultrasound, they found subcutaneous breast edema in 69-70% of the axillary clearance node patients and 28% of the sentinel node biopsy patients.[iii] Sentinel node biopsy reduces arm lymphedema risk compared to axillary clearance, but it poses a significant risk for breast lymphedema.

References are below--

Carol

[i] Paskett ED, Naughton MJ, McCoy TP, Case LD, Abbott JM. (2007) The epidemiology of arm and hand swelling in premenopausal breast cancer survivors.Cancer Epidemiology, Biomarkers & Prevention, 16(4): 775-782.

[ii] Shah C, Vicini FA (2011) Breast cancer-related arm lymphedema: Incidence rates, diagnostic techniques, optimal management and risk reduction strategies.International Journal of Radiation Oncology·Biology·Physics, 81(4): 907-914.

[iii] Rönkä RH, Pamilo MS, von Smitten KA, Leidenius MH. (2004) Breast lymphedema after breast conserving treatment. Acta Oncologica. 43(6):551-7.

I've wondered about the radiation I had. I did 3 weeks instead of 6/7 weeks. It's more radiation daily for a shorter time period. Accepted practice in some european countries but considered a trial in the US. I had 1 node removed, I wasn't over weight and I was very active. I'm wondering if there is any info gathering done on the newer techniques such as sentinel node removal, interoperative radiation or the radiation trial I did. Would be interesting to find out.