A recent study led by researchers at Karolinska Institutet has found that it is possible to leave most of the lymph nodes in the armpit, even if one or two of them have metastases larger than two millimeters. The study, published in the New England Journal of Medicine, included nearly 2,800 patients from five different countries. The results suggest that for patients with breast cancer, it may be possible to avoid the more extensive axillary dissection surgery, which carries a risk of arm lymphedema. This could lead to gentler surgery and fewer side effects for patients.
Breast cancer can spread to the lymph nodes in the armpit, but when tumors are found only in the breast and armpit lymph nodes, it is considered a localized disease with the goal of curing the patient. However, a challenging question for breast cancer surgeons arises when patients have metastases in the armpit, first detected during surgery. Performing an axillary dissection increases the risk of arm lymphedema, which can cause swelling, pain, and mobility restrictions. The researchers wanted to find out if it was safe to leave the remaining lymph nodes intact, even if metastases were present in one or two sentinel lymph nodes.
Patients with metastases larger than two millimeters, known as macrometastases, in one or two sentinel lymph nodes were included in the study. After sentinel node surgery, the patients were randomly assigned to either undergo axillary dissection or leave the rest of the armpit undisturbed. The results showed that recurrences were equally common in both groups, indicating that postoperative treatment seems to be sufficient to eliminate remaining tumor cells. Additionally, the study found that more patients who underwent axillary dissection reported arm-related problems compared to those who only had the sentinel lymph nodes removed.
The researchers concluded that for patients with a maximum of two macrometastases in the sentinel lymph nodes, it is safe to forgo axillary dissection. Instead, radiation therapy to the armpit can be used as a replacement, resulting in fewer arm-related complications. This new approach has already been implemented in clinical practice in Sweden. The study, called SENOMAC, was funded by various grants from organizations such as the Swedish Research Council and the Swedish Cancer Society, highlighting the importance of research in improving treatment options and outcomes for patients with breast cancer.
Overall, the study provides valuable insights into the treatment of breast cancer patients with metastases in the armpit lymph nodes. By avoiding axillary dissection and opting for radiation therapy instead, patients can experience fewer side effects and complications related to lymphedema. The results suggest that postoperative treatment, along with targeted therapy, can effectively eliminate remaining tumor cells, reducing the need for more invasive surgical procedures. This new approach has the potential to improve the quality of life for patients with breast cancer and may lead to gentler treatment options in the future. Further research and clinical trials will be needed to validate these findings and assess long-term outcomes for patients.
