HonCode

Go Back   HER2 Support Group Forums > her2group
Register Gallery FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools Display Modes
Old 05-08-2009, 09:11 AM   #1
Lani
Senior Member
 
Join Date: Mar 2006
Posts: 4,778
another aspect of breast cancer treatment dogma questioned

Some Breast Cancer Patients with Node-Positive Disease Derive No Significant Benefit from Axillary Lymph Node Dissection
[American College of Surgeons]
CHICAGO: A recent observational study of 97,000 women with breast cancer and nodal metastases indicates that there is no appreciable difference in axillary recurrence and survival between those who undergo sentinel lymph node (SLN) biopsy alone versus SLN biopsy with the more invasive completion axillary lymph node dissection (ALND). This new analysis from the National Cancer Data Base (NCDB) of the American College of Surgeons (ACS) was recently published online in the Journal of Clinical Oncologyand will appear in a print version of the journal within the next few weeks. The study's authors analyzed data from approximately 1,400 hospitals. These women with breast cancer underwent SLN biopsy for clinically node-negative breast cancer from 1998 to 2005 and were found to have nodal metastases. The authors found that some patients with lymph node metastases identified on sentinel node biopsy may not need to have the rest of their lymph nodes removed.
"In certain patients, particularly those with microscopic nodal metastases, one may not need to perform a completion axillary lymph node dissection. However in patients with more tumor burden in their lymph nodes—with macroscopic disease—completion ALND may provide a small benefit and potentially result in better outcomes," according to lead author Karl Bilimoria, MD, MS, who was an American College of Surgeons (ACS) Research Fellow at the time the analysis was performed, and is a surgical resident at the Feinberg School of Medicine, Northwestern University, Chicago, IL.
Despite these findings, many women with axillary nodal involvement confirmed via SLN biopsy still undergo completion ALND, cautioned coauthor David J. Winchester, MD, FACS, of Northwestern University Medical School. "The average physician out there may be overusing axillary lymph node dissection in many patients," Dr. Winchester explained. "We have relied upon that operation too much, and this paper points out we may not need to do it in terms of a survival difference or a regional recurrence difference. This is an operation associated with significant morbidity." Among the morbidities linked to ALND are a lifetime risk of lymphedema, problematic cosmetic outcomes, longer recovery times and more postoperative pain than SLN biopsy alone. The researchers detected a shift in practice patterns that made sense in light of their findings. "For microscopic nodal disease from 1998 to 2005, the proportion of patients undergoing SLN biopsy alone without a completion nodal dissection increased considerably, from about 25 percent to 45 percent, whereas for patients with more substantial nodal metastases, the macroscopic group, the proportion stayed fairly constant over the time course of the study," Dr. Bilimoria said. "This shift in practice patterns makes sense as physicians may have anecdotally found that completion nodal dissection is not necessary in all patients." The study findings along with conclusions from small institutional series and previous clinical trials can be interpreted together and potentially change how physicians counsel their patients. "These data allow clinicians to have a discussion with their patients, especially those with microscopic nodal metastases, whether a completion axillary lymph node dissection would be beneficial," Dr. Bilimoria concluded.
In addition to Drs. Bilimoria and Winchester, contributing authors were David J. Bentrem, MD, FACS,(Northwestern University); Nora M. Hansen, MD, FACS, (Northwestern University); Kevin P. Bethke, MD, FACS,(Northwestern University); Alfred W. Rademaker, PhD, (Northwestern University); Clifford Y. Ko, MD, FACS, (University of California at Los Angeles and VA Greater Los Angeles Healthcare System); David P. Winchester, MD, FACS, (North Shore University Health System).
EARLY VIEW: ABSTRACT: Comparison of Sentinel Lymph Node Biopsy Alone and Completion Axillary Lymph Node Dissection for Node-Positive Breast Cancer
[Journal of Clinical Oncology]
Purpose: For women with breast cancer, the role of completion axillary lymph node dissection (ALND) after identification of nodal metastases by sentinel lymph node biopsy (SLNB) has been questioned. Our objectives were to assess national nodal evaluation practice patterns and to examine differences in recurrence and survival for SLNB alone versus SLNB with completion ALND.
Patients and Methods: From the National Cancer Data Base (1998 to 2005), women with clinically node-negative breast cancer who underwent SLNB and who had nodal metastases were identified. Practice patterns and outcomes were examined for patients who underwent SLNB alone versus SLNB with completion ALND (median follow-up, 63 months).
Results: Of 97,314 patients, 20.8% underwent SLNB alone, and 79.2% underwent SLNB with completion ALND. In 2004 to 2005, patients were significantly more likely to undergo SLNB alone if they were older, had smaller tumors, or were treated at non-National Cancer Institute-designated cancer centers. In patients with macroscopic nodal metastases (n = 20,075 during 1998 to 2000), there was a nonsignificant trend toward better outcomes for completion ALND (v SLNB alone) after analysis was adjusted for differences between the two groups: axillary recurrence (hazard ratio [HR], 0.58; 95% CI, 0.32 to 1.06) and overall survival (HR, 0.89; 95% CI, 0.76 to 1.04). In patients with microscopic nodal metastases (n = 2,203 during 1998 to 2000), there were no significant differences in axillary recurrence or survival for patients who underwent SLNB alone versus completion ALND.
Conclusion: Compared with SLNB alone, completion ALND does not appear to improve outcomes for breast cancer patients with microscopic nodal metastases; however, there was a nonsignificant trend toward better outcomes with completion ALND for those with macroscopic disease.
Lani is offline   Reply With Quote
Old 05-08-2009, 12:23 PM   #2
StephN
Senior Member
 
StephN's Avatar
 
Join Date: Nov 2004
Location: Misty woods of WA State
Posts: 4,128
Question How do they know ...?

I can see where there is a trend to find ways to justify fewer surgeries in many health areas, not just cancer.

But the purpose of the full node dissection was for "staging" and for trying to halt the progression of the cancer by surgery.

Also, how do they define "macroscopic" disease? Are they imaging via ultrasound or PET to decide who has micro-disease and does not get the full node dissection??
__________________
"When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." H.D. Thoreau
Live in the moment.

MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
StephN is offline   Reply With Quote
Reply

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Forum Jump


All times are GMT -7. The time now is 03:59 PM.


Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2024, vBulletin Solutions, Inc.
Copyright HER2 Support Group 2007 - 2021
free webpage hit counter