(Press-News.org) CHICAGO – Among patients with early-stage breast cancer that had spread to a nearby lymph node and who received treatment that included lumpectomy and radiation therapy, women who just had the sentinel lymph node removed (the first lymph node to which cancer is likely to spread from the primary tumor) did not have worse survival than women who had more extensive axillary lymph node dissection (surgery to remove lymph nodes found in the armpit), according to a study in the February 9 issue of JAMA.
Axillary lymph node dissection (ALND) has been part of breast cancer surgery since the use of radical mastectomy and reliably identifies nodal metastases. "Sentinel lymph node dissection (SLND) accurately identifies nodal metastasis of early breast cancer, but it is not clear whether further nodal dissection [removal] affects survival," the authors write. "ALND, as a means for achieving local disease control, carries an indisputable and often unacceptable risk of complications such as seroma [a mass or swelling caused by the localized accumulation of serum within a tissue or organ], infection, and lymphedema [condition in which excess fluid called lymph collects in tissues and causes swelling]."
Armando E. Giuliano, M.D., of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif., and colleagues conducted a study to determine the effects of ALND on overall survival in patients with SLN metastases treated with lumpectomy (surgical removal of a tumor without removing much of the surrounding tissue or lymph nodes) and radiation therapy. The trial was conducted at 115 sites and enrolled patients from May 1999 to December 2004. Patients were women with T1-T2 (stage of tumor) invasive breast cancer, no palpable adenopathy (enlarged lymph nodes), and 1 to 2 SLNs containing metastases.
Patients with SLN metastases identified by SLND were randomized to undergo ALND or no further axillary treatment. Those randomized to ALND underwent dissection of 10 or more nodes. Of 891 patients, 445 were randomly assigned to the ALND group and 446 to the SLND-alone group.
As expected, there was a difference between ALND and SLND-alone treatment groups in total number of removed lymph nodes and total number of tumor-involved nodes; the median (midpoint) total number of nodes removed was 17 in the ALND group and 2 in the SLND-alone group. At a median follow-up of 6.3 years, there were 94 deaths (SLND-alone group, 42; ALND group, 52). The use of SLND alone compared with ALND did not appear to result in statistically inferior survival, with the 5-year over all survival rates being 92.5 percent in the SLND-alone group and 91.8 percent in the ALND group. Disease-free survival did not differ significantly between treatment groups, with 5-year disease-free survival being 83.9 percent for the SLND-alone group and 82.2 percent for the ALND group.
The rate of wound infections, axillary seromas, and paresthesias (prickly, tingling sensations) among patients in the trial was higher for the ALND group than for the SLND-alone group (70 percent vs. 25 percent).
The authors note that these results suggest that breast cancer patients, such as those in this study, do not benefit from the addition of ALND in terms of local control, disease-free survival, or overall survival, and that ALND may no longer be justified for certain patients. "Implementation of this practice change would improve clinical outcomes in thousands of women each year by reducing the complications associated with ALND and improving quality of life with no diminution in survival."
###
(JAMA. 2011;305[6]:569-575. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Management of Axillary Lymph Node Metastasis in Breast Cancer - Making Progress
Grant Walter Carlson, M.D., and William C. Wood, M.D., of Emory University, Atlanta, write in an accompanying editorial that the adage that less is more may be applicable regarding surgery for breast cancer.
"Giuliano and colleagues have made an important contribution to the surgical management of SLN metastasis in breast cancer," they write. Following the lead of other clinical investigators, "these randomized clinical trials have shown that less surgery combined with more radiation and chemotherapy have improved survival for women with breast cancer. Taken together, findings from these investigators provide strong evidence that patients undergoing partial mastectomy, whole-breast irradiation, and systemic therapy for early breast cancer with microscopic SLN metastasis can be treated effectively and safely without ALND."
(JAMA. 2011;305[6]:606-607. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
END
CHICAGO – Patients who underwent coronary artery bypass graft surgery and had elevated levels of the cardiac enzymes creatine kinase or troponin in the 24 hours following surgery had an associated intermediate and long-term increased risk of death, according to a study in the February 9 issue of JAMA.
"About 400,000 coronary artery bypass grafting (CABG) procedures are performed annually in the United States, giving public health significance to factors that affect the outcome of these procedures," the authors write. Increases in creatine kinase (CK-MB) or troponin levels ...
CHICAGO – In a study that included infants from South Africa, those who were exposed to human immunodeficiency virus (HIV) at birth but did not become infected had lower levels of antibodies to diseases such as pertussis, tetanus and pneumococcus, compared to infants of non-HIV infected mothers, according to a study in the February 9 issue of JAMA.
Infectious diseases account for nearly 6 million deaths worldwide annually in children younger than 5 years. Immunization against vaccine-preventable infections is essential to reducing childhood mortality. "The high prevalence ...
The incidence of major congenital birth abnormalities was slightly higher in the offspring of male cancer survivors compared with children of fathers with no history of cancer, according to a study published online February 8th in the Journal of the National Cancer Institute.
The increasing number of male cancer survivors has given rise to concerns about the health of their offspring. Although previous studies on children conceived naturally have been reassuring about the health of the children, very few studies have looked at results among children conceived through ...
New research from Warwick Medical School published today in the European Heart Journal shows that prolonged sleep deprivation and disrupted sleep patterns can have long-term, serious health implications. Leading academics from the University have linked lack of sleep to strokes, heart attacks and cardiovascular disorders which often result in early death.
Professor Francesco Cappuccio from the University of Warwick Medical School, explained: "If you sleep less than six hours per night and have disturbed sleep you stand a 48 per cent greater chance of developing or dying ...
There will be nearly 1.3 million deaths from cancer in Europe in 2011 according to predictions from a study published in the cancer journal, Annals of Oncology today (Wednesday 9 February) [1].
The estimates, which have been reached after researchers used for the first time in Europe a new mathematical model for predicting cancer mortality, show a fall in overall cancer death rates for both men and women when compared to 2007. But they also highlight some areas of concern, particularly rising rates of lung cancer in women.
Researchers, led by Professor Carlo La Vecchia ...
At a time when the effects of paediatric oncology research have meant that more and more children survive cancer, its funding is too low and dependent on short-term grants to be able to sustain this improvement in the long-term, says a report supported by the EU-funded 7th Framework Programme project Eurocancercoms and published on-line in ecancer today*. The authors also looked at the citation impact of paediatric oncology papers and found that childhood cancer research is once again the poor relation; unlike cancer papers in general, paediatric oncology papers received ...
DETROIT ¬– A Henry Ford Hospital study has found that a pharmacist-directed anticoagulation service improves the way medication is managed for patients with heparin-induced thrombocytopenia (HIT), a common but life-threatening thromboembolic disorder.
Researchers found that patients treated by the anticoagulation service had a favorable response to alternative anticoagulant drugs three times faster and were 32 percent more likely to receive proper dosage than patients who were treated with the same drugs by the patient's primary medical team.
This is the first time ...
Researchers at Mount Sinai School of Medicine have found that even small amounts of damage to heart muscle during coronary artery bypass grafting (CABG) is associated with an increased risk of death, even among patients who initially do well following surgery. The study is published in the February 9 issue of the Journal of the American Medical Association (JAMA).
Small elevations of troponin and creatine phosphokkinase – chemicals called enzymes that are released by heart muscle cells when they are damaged – have often been dismissed as unimportant. But Mount Sinai ...
University of Alberta researchers Péter Molnár, Andrew Derocher and Mark Lewis studied the reproductive ecology of polar bears in Hudson Bay and have linked declining litter sizes with loss of sea ice.
The researchers say projected reductions in the number of newborn cubs is a significant threat to the western Hudson Bay polar-bear population, and if climate change continues unabated the viability of the species across much of the Arctic will be in question.
Using data collected since the 1990s researchers looked at the changing length of time Hudson Bay is frozen ...
Bacteria often attack with toxins designed to hijack or even kill host cells. To avoid self-destruction, bacteria have ways of protecting themselves from their own toxins.
Now, researchers at Washington University School of Medicine in St. Louis have described one of these protective mechanisms, potentially paving the way for new classes of antibiotics that cause the bacteria's toxins to turn on themselves.
Scientists determined the structures of a toxin and its antitoxin in Streptococcus pyogenes, common bacteria that cause infections ranging from strep throat to life-threatening ...
