Patients with breast cancer who undergo radiotherapy to the armpit area instead of surgery to remove lymph nodes may be less likely to develop lymphedema, according to findings presented on Mar. 25 at the 15th European Breast Cancer Conference (EBCC15) in Barcelona.
Lymphedema is a painful swelling that can occur after lymph node removal, affecting quality of life for many patients. The new results suggest that axillary radiotherapy could be as effective as surgery at eliminating remaining cancer cells while potentially lowering the risk of this complication.
The pilot phase of an ongoing international phase III clinical trial compared axillary radiotherapy (ART) and axillary lymph node dissection (ALND) in breast cancer patients who had received chemotherapy or hormone therapy before surgery and whose cancer had spread to one or two lymph nodes. Over two years, no patient in the ART group experienced a recurrence of cancer in the armpit area, while one case occurred in the ALND group. Lymphedema was more common after ALND (26.7%) than ART (18.9%), though this difference was not statistically significant. Disease-free and overall survival rates were similar between groups during follow-up.
Professor Amparo Garcia-Tejedor, leading the trial from Bellvitge University Hospital and Institut Català d'Oncologia, said: "These results indicate that ART instead of ALND is feasible and has good cancer outcomes at two years." She added: "Our trial is designed to provide the necessary data to definitively answer this question and to ensure that any future change in standard practice is safe in terms of cancer outcomes and is also beneficial for patients."
Dr Maria Laplana-Torres from Hospital Clínic de Barcelona reported that while skin damage was more frequent with ART than ALND, it tended to be temporary and treatable. She said: "We found that treating the axilla with radiotherapy instead of extensive surgery can avoid a more aggressive operation without compromising treatment safety... These results show that axillary radiotherapy may be a safe and less invasive option for some women treated with chemotherapy or hormone therapy before surgery." More than 500 patients have now joined the main phase III trial; researchers expect recruitment will take about three more years followed by five years' follow-up.
Professor Garcia-Tejedor concluded: "If the study confirms the safety and effectiveness of axillary treatment de-escalation, the implications for both patients and clinicians could be substantial... For clinicians, these findings would support a paradigm shift in axillary management." Professor Isabel Rubio, Chair of EBCC15 but not involved with this research, commented: "These findings from the pilot phase ... are encouraging... Once the trial reports its final results ... we will know whether radiotherapy rather than surgery is safe for patients who have received neoadjuvant treatments."
