Axillary lymph node dissection effective for breast cancer with sentinel-node macrometastases: Study

A recent clinical trial determined that omitting the routine procedure of completion axillary-lymph-node dissection (ALND) does not compromise the survival rates of patients with certain types of breast cancer by potentially setting the stage for less invasive treatment options. The findings were published in The New England Journal of Medicine.

The study included 2,766 participants across five countries from January 2015 to December 2021 and looked at patients with clinically node-negative primary T1 to T3 breast cancers where the patients had either one or two sentinel-node macrometastases. These patients would undergo ALND, where additional lymph nodes are surgically removed after the sentinel lymph node is found to contain cancer.

The participants were randomly assigned to either proceed with the standard ALND or to undergo only a sentinel-node biopsy (SNB) where only the first few lymph nodes into which a tumor drains are removed and examined. The primary goal was to compare overall survival rates while the secondary outcomes focused on the recurrence-free survival

The omission of ALND did not show inferior results when compared to the traditional approach. In fact, the 5-year recurrence-free survival rates were impressive with 89.7% in the SNB-only group and 88.7% in the dissection group. The hazard ratio was 0.89 (95% CI, 0.66 to 1.19) which was significantly under the preset threshold.

Also, the vast majority of patients in both groups received radiation therapy that included nodal target volumes, with 89.9% in the SNB-only group and 88.4% in the group undergoing dissection. This consistency in post-operative treatment underscores the rigorous standards maintained across the study.

These findings are pivotal as they suggest that for certain patients with node-negative breast cancer, the less invasive procedure of sentinel-node biopsy alone could be just as effective as more extensive surgery to prevent cancer recurrence. This could directly translate to fewer surgical complications, quicker recovery times and potentially lower healthcare costs. Overall, the significant changes in the surgical management of breast cancer offers many patients a less invasive option without compromising their long-term health outcomes.

Reference:

de Boniface, J., Filtenborg Tvedskov, T., Rydén, L., Szulkin, R., Reimer, T., Kühn, T., Kontos, M., Gentilini, O. D., Olofsson Bagge, R., Sund, M., Lundstedt, D., Appelgren, M., Ahlgren, J., Norenstedt, S., Celebioglu, F., Sackey, H., Scheel Andersen, I., Hoyer, U., Nyman, P. F., … Christiansen, P. (2024). Omitting Axillary Dissection in Breast Cancer with Sentinel-Node Metastases. In New England Journal of Medicine (Vol. 390, Issue 13, pp. 1163–1175). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2313487