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Some patients with early-stage breast cancer may be able to avoid axillary lymph node dissection
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SAN ANTONIO — Sentinel lymph node biopsy during surgery that identified no evidence of cancer appeared associated with low risk for recurrence in axillary lymph nodes among certain patients with early-stage breast cancer, according to follow-up results of the GANEA 2 trial presented at San Antonio Breast Cancer Symposium.
The finding — which applied to patients who had large operable breast tumors and no clinical signs of malignancy in the axillary lymph nodes prior to neoadjuvant chemotherapy — suggests these patients may be able to avoid axillary lymph node dissection.
“However, because we do not know the clinical risk of a false-negative case after neoadjuvant chemotherapy, sentinel lymph node biopsy is not proven to be safe outside of clinical trial,” Jean-Marc Classe, MD, PhD, head of surgery at the Institute de Cancerologie de l’Ouest René Gauducheau in France, said during a presentation. “For patients without proof of node involvement before treatment, sentinel lymph node biopsy alone after neoadjuvant chemotherapy without axillary lymphadenectomy seems to be safe within the limits of our study.”
Axillary lymph node dissection is associated with a high risk for serious complications and long-term sequelae. Whether the less invasive sentinel lymph node biopsy alone after neoadjuvant therapy is safe remains unknown.
The prospective, multi-institutional GANEA 2 trial included 590 patients treated at 17 institutions between July 2010 and February 2014. All patients had large, operable breast tumors, with no cancer in the lymph nodes as determined by fine-needle cytology.
All patients underwent neoadjuvant chemotherapy, followed by surgery and sentinel lymph node biopsy.
Investigators detected cancer cells in sentinel lymph node biopsy samples from 139 patients, all of whom underwent axillary lymph node dissection.
Sentinel lymph node biopsy samples from 432 patients contained no detected cancer cells. Follow-up (median, 35.8 months) was available for 416 of these patients, none of whom underwent axillary lymph node dissection.
Among this group, 3-year DFS was 94.8% and 3-year OS was 98.7%. One patient had homolateral axillary lymph node relapse, three had metastatic relapse, and six developed disease recurrence in the breasts.
“The disease-free and overall survival results we observed for the patients who underwent only a sentinel lymph node biopsy after neoadjuvant chemotherapy are comparable with the historical survival rates for patients in this situation who have axillary lymph node dissection rather than sentinel lymph node biopsy,” Classe said in a press release. “Therefore, an axillary lymph node dissection could be avoided by patients who have no signs of cancer in the axillary lymph nodes following a sonographic axillary assessment prior to neoadjuvant chemotherapy and sentinel lymph node biopsy during surgery after neoadjuvant chemotherapy.” – by Jennifer Southall
Reference:
Classe JM, et al. Abstract S2-07. Presented at: San Antonio Breast Cancer Symposium; Dec. 6-10, 2016; San Antonio, Texas.
Disclosure: The study was funded by a grant from Institut National du Cancer. Classe reports no relevant financial disclosures. Please see the abstract for a list of all other researchers’ relevant financial disclosures.