Adjuvant Therapy for Breast Cancer Not Guided by Node Dissection


Last Updated: 2010-01-20 19:13:32 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - In patients with breast cancer and tumor-positive sentinel nodes, the extent of nodal involvement does not significantly influence the use of adjuvant therapies, researchers report in the December 28th online issue of the Journal of Clinical Oncology.

"Knowledge of the number of positive lymph nodes in patients with invasive breast cancer does not appear to have impact on the type of adjuvant systemic treatments," senior author Dr. Emiel J. T. Rutgers told Reuters Health by email. "Apparently," he added, "treating physicians do not use this information, contrary to the clinical practice in two past decades."

Dr. Rutgers, of The Netherlands Cancer Institute, Amsterdam, and colleagues came to this conclusion after studying data from a phase III trial in which women with unifocal invasive breast cancer and clinically negative lymph nodes were randomly assigned, in the case of a positive sentinel node, to axillary lymph node dissection (ALND) or axillary radiation therapy (ART). Adjuvant therapy was then given according to guidelines at each of the 26 study centers.

Of the 658 women with positive sentinel nodes, 300 in the ALND arm and 266 in the ART arm were evaluated for this report.

With ART, the researchers point out, "the extent of nodal involvement will remain unknown and cannot be used to select patients for adjuvant systemic therapy."

On multivariate analysis, however, there was no significant between-group difference in the proportion of patients who underwent adjuvant chemotherapy: 58% in the ALND group and 61% in the radiation group. Adjuvant endocrine therapy was given to 78% in the ALND group and 76% in the ART group.

Multivariate analysis also showed that the decision to use chemotherapy was guided mainly by "age, tumor grade, multifocality, and the size of sentinel node metastasis and not by the nodal extent," the authors write.

This suggests "that positive node classification is only of limited additional importance compared with these other variables," they said.

In fact, even when the ALND group was considered separately, the extent of nodal involvement did not significantly affect the use of adjuvant chemotherapy.

"Adjuvant chemotherapy is mainly based on tumor and patient characteristics and sentinel node biopsy status," the researchers conclude, adding, "knowledge of further nodal involvement is redundant."

J Clin Oncol 2009.

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