CHICAGO -- Skipping axillary lymph node dissection (ALND) for selected patients with locally advanced breast cancer did not adversely affect survival, findings from a randomized trial showed.
Patients who omitted ALND after a positive sentinel lymph node biopsy (SLNB) had a 5-year overall survival (OS) rate of 94.4% as compared with 93.4% for those who underwent completion ALND. Arm symptoms occurred less frequently with omission of ALND, and severe problems with arm function occurred more than three times as often in patients who had completion ALND.
Almost all patients had radiation therapy, and completion ALND detected additional cancer in a third of cases, reported Jana de Boniface, MD, PhD, of the Karolinska Institute in Stockholm, at the American Society of Clinical Oncology (ASCO) annual meeting.
"Survival after omission of completion ALND is noninferior to completion ALND," de Boniface said during a press briefing prior to the meeting. "Omission of completion ALND results in significantly less arm-related complications, better quality of life, and better arm physical function."
Therefore, "omission of completion ALND should be standard of care in breast cancer that has spread to one or two sentinel lymph nodes," she added. "This recommendation needs to be viewed in the context, of course, that adjuvant local-regional radiotherapy was received by most patients in the SENOMAC trial. At the moment, we have another ongoing randomized trial, the T-REX trial, which looks at the omission of local-regional radiotherapy in the same patient group."
