June 18, 2013

Use of Radiation to Treat Axillary Lymph Nodes Reduces Lymphedema Risk in Early Breast Cancer


For women with early-stage breast cancer and a positive sentinel lymph node, use of radiation—rather than surgery—to treat the axillary lymph nodes appears to be effective and to have a lower risk of lymphedema. These results were presented at the 2013 Annual Meeting of the American Society of Clinical Oncology (ASCO).

For women with early breast cancer, determining whether the cancer has spread to the axillary (under the arm) lymph nodes is an important part of cancer staging. Evaluation of the axillary nodes often involves a sentinel lymph node biopsy. The sentinel nodes are the first lymph nodes to which cancer is likely to spread. If the sentinel nodes contain cancer, women often undergo more extensive lymph node surgery (axillary lymph node dissection). A common side effect of axillary lymph node surgery is lymphedema of the arm—swelling of the arm due to an accumulation of lymph fluid.

To evaluate a different approach to treating the axillary lymph nodes, researchers in Europe conducted a Phase III clinical trial (the AMAROS trial). The study included 1,425 women with early-stage breast cancer and a positive sentinel lymph node (a sentinel lymph node that contained cancer). Women underwent additional lymph node treatment with either surgery or radiation therapy.

  • Five-year overall survival was 93.3% among women who underwent lymph node surgery and 92.5% among women who received radiation to the lymph nodes. Survival without a cancer recurrence was 86.9% with surgery and 82.7% with radiation. These differences between study groups did not meet the criteria for statistical significance, suggesting that they could have occurred by chance alone.
  • Lymphedema was less common among women in the radiation group. During the first year after treatment, lymphedema developed in 40% of the women who had lymph node surgery and 22% of women who had radiation to the lymph nodes. The frequency of lymphedema decreased during subsequent years, but continued to favor radiation: at five years, 28% of women in the surgery group and 14% of women in the radiation group had lymphedema.

This study suggests that radiation therapy to the lymph nodes may be an alternative to lymph node surgery for selected women with early-stage breast cancer. The two treatment approaches appear to have similar effectiveness, but radiation therapy may be less likely to cause lymphedema.

Reference: Rutgers EJ, Donker M, Straver ME et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer patients: final analysis of the EORTC AMAROS trial (10981/22023). Presented at the 49th Annual Meeting of the American Society of Clinical Oncology. May 31-June 4, 2013; Chicago, IL. Abstract LBA1001.


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Tags: Breast Cancer, Stages II-III Breast Cancer, Uncategorized