Sentinel Lymph Node Dissection Non-Inferior to Axillary Node


“Ten-year overall survival for primary breast cancer patients treated with sentinel lymph node dissection (SLND) alone is similar to that seen in those treated with axillary lymph node dissection (ALND), according to a study published in the Sept. 12 issue of the Journal of the American Medical Association.

“Armando E. Giuliano, M.D., from the Cedars-Sinai Medical Center in Los Angeles, and colleagues compared the 10-year overall survival of patients with  metastases treated with breast-conserving therapy and SLND alone without ALND (446 patients) versus women treated with ALND (445 patients). The women, with clinical T1 or T2 invasive , all had planned lumpectomy, tangential whole-breast irradiation, and adjuvant systemic therapy.”

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Axillary Radiotherapy Reduced Morbidity in Breast Cancer with Positive Sentinel Node

The gist: Some women with breast cancer have some cancer cells in the sentinel lymph node. The standard treatment for a positive sentinel node is a surgery called axillary lymph node dissection. However, that procedure is associated with some harmful side effects. Recent research shows that an alternative treatment called axillary radiotherapy might be just as effective, with fewer side effects.

“Axillary radiotherapy and axillary lymph node dissection achieved similar rates of regional control in patients with breast cancer who have a positive sentinel node, according to results of a randomized phase 3 trial.

“However, radiotherapy was associated with significantly less morbidity.

“Axillary lymph node dissection has been the standard treatment for patients with breast cancer who have a positive sentinel node. Dissection provides excellent control but also is associated with harmful side effects, according to background information provided by researchers.

“In the current multicenter, open-label study, Mila Donker, MD, of the department of surgical oncology at Netherlands Cancer Institute, and colleagues assessed whether axillary radiotherapy provided comparable regional control with fewer side effects.”

Radiation-Free Method to Track Suspicious Lymph Nodes in Case of Cancer

“Researchers at the UT Research Institute MIRA have developed a new method for tracing the sentinel lymph node, the node by which you can tell whether a patient’s cancer has spread. Martijn Visscher demonstrated that you can find the node using magnetic nanoparticles, a simple set-up and a clever way of measuring. The patented find, which can quickly be put into practice, will prevent patients from being unnecessarily exposed to ionizing radiation. Visscher will obtain his doctoral degree on 27 August.

“In order to determine whether a patient suffering from cancer has metastases, doctors will start looking for the sentinel lymph node, the first lymph node after the tumour. When cells break free from the tumour, that’s where they go first. Therefore, if a patient has a ‘clean’ sentinel lymph node, the cancer has essentially not spread. Right now, tracking this node generally occurs with the help of radioactive particles. Downside to this method is that you expose the patient to damaging radiation. Because the particles are very perishable and potentially dangerous, they’re a logistic nightmare: both in the area of transport and the scheduling of surgeries (in addition, many patients remain deprived of the particles because there’s no suitable nuclear facility in the vicinity). In the Netherlands, thousands of cancer patients undergo the sentinel lymph node procedure every year.”