“When a suspicious lesion shows up in the lungs on a CT scan, the first thing your doctor wants to know is whether it’s cancerous. A specialist will pass a long, thin bronchoscope into your airway in the hope of grabbing a few cells of the growth so they can be examined under a microscope.
“But some of these lesions or nodules are deep in the small branches of the lungs, out of reach of the bronchoscope, which is about the diameter of a pen. Other times, the results are inconclusive. That has left only two ways to determine whether the abnormality is cancerous: inserting a needle through the chest wall and into the tumor, or surgically opening a patient’s chest to find it (and remove it if necessary).
“The first procedure carries a 15 percent risk of collapsing a lung (pneumothorax), as well as infection. The second is serious surgery that requires general anesthesia and results in the loss of lung tissue. Both are in-patient procedures that carry the cost and other risks of hospitalizations. In about a third of the surgeries, the growth turns out to be benign, meaning the surgery was unnecessary.
“Women with lymph node-positive breast cancer who demonstrate complete nodal response by axillary ultrasound after neoadjuvant chemotherapy may be able to avoid axillary dissection, according to study results.
“ ‘Our goal here is really to try to get away from, “Every patient with breast cancer needs these drugs and this amount of chemotherapy and surgery,” and instead to personalize surgical treatment based on how the patient responds to chemotherapy,’ Judy Boughey, MD, chair of the division of surgery research at Mayo Clinic in Rochester, Minnesota, said in a press release.
“The American College of Surgeons Oncology Group (ACOSOG) Z1071 trial included 687 patients with T0-4, N1-2, M0 primary invasive breast cancer. All patients completed neoadjuvant chemotherapy, underwent sentinel lymph node surgery and axillary dissection, and had axillary ultrasound images available for review.
“Previously published results indicated a 12.6% false-negative rate for sentinel lymph node surgery after neoadjuvant chemotherapy for patients who presented with node-positive disease and had two or more sentinel lymph nodes identified and removed. This false-negative rate exceeded the predetermined acceptable rate of 10%. The result suggested patient selection or technique must be improved prior to widespread adoption of sentinel lymph node surgery in this setting, according to study background…
“ ‘That’s one of the really nice things about giving chemotherapy up front,’ Boughey said. ‘It allows us to be less invasive with surgery, both in terms of breast surgery and lymph node surgery, and to tailor treatment based on response to chemotherapy.’ “
The gist: Radiotherapy after breast-conserving surgery to remove the tumor may give long-term benefits to women with ductal carcinoma in situ (DCIS). In a clinical trial, researchers followed the patients for 20 years after their treatment. Patients who had gotten radiotherapy after surgery were less likely to have their cancer come back later in the same breast.
“The 20-year follow-up of the Swedish randomized SweDCIS trial, reported by Wärnberg et al in the Journal of Clinical Oncology, shows a continued benefit of radiotherapy after breast-conserving surgery for ductal carcinoma in situ (DCIS) in preventing ipsilateral disease. A nonsignificant increase in contralateral breast disease was observed in the radiotherapy group…
“The investigators concluded: ‘Use of adjuvant radiotherapy is supported by 20-year follow-up. Modest protection against invasive recurrences and a possible increase in contralateral cancers still call for a need to find groups of patients for whom radiotherapy could be avoided or mastectomy with breast reconstruction is indicated.’ “