April 30, 2014 | by Nicole White
For some breast cancer patients whose cancer has also spread to their axillary lymph nodes, radiation might be a better option than surgically removing the nodes, a new study suggests.
Previous studies have shown that, when looking strictly at survival, both approaches are about equal. The new study finds that radiation therapy, which is emerging as a treatment protocol for breast cancer affecting the lymph nodes, is associated with significantly fewer complications than removal of the nodes.
The results from the international multicenter trial are being presented in Las Vegas at Breast Cancer Update 2014, the 15th annual meeting of the American Society of Breast Surgeons. The study included nearly 5,000 randomized patients. It found those patients with positive sentinel nodes treated with radiation suffered less lymphedema – swelling, usually in the arms or legs associated with blockage in the lymphatic system – as well as less arm parasthesia and other postsurgery complications.
But breast cancer specialists aren't advising women to automatically choose radiation over lymph node removal. “Radiation to these lymph nodes can be considered as one option for positive nodes in the treatment of breast cancer for women, but it does not necessarily mean that this therapy should completely replace removal of the lymph nodes,” said Laura Kruper, M.D., director of the Rita Cooper Finkel and J. William Finkel Women’s Health Center, who was not involved in the study, in an interview with HealthDay. “It’s an interesting study. It confirms that an increased body mass index is associated with higher risk for lymphedema, but it’s the first to find that premenopausal status is associated with a higher lymphedema risk.”
Combining radiation and lymph node removal increased the risk of lymphedema, and researchers from the Netherlands Cancer Institute, who conducted the study, recommended avoiding combining the treatments if at all possible.
Lymphedema is a potential side effect of breast cancer treatment and can appear in some patients months or even years after treatment ends. The lymphatic system helps the immune system fight off infection and clears debris from the body by circulating a thin, clear fluid through tissues. The lymph nodes act as filters, removing harmful substances from the lymph fluid which then drains back into the blood stream.
Lymphedema occurs when an abnormal buildup of that fluid causes swelling – usually in the arm in breast cancer patients – and usually happens when lymph nodes are removed or damaged.
The condition can be painful, and in severe cases, the limb can be difficult or impossible to use. Fortunately, most breast cancer patients do not have this complication, and most cases are less severe than they were in the past.
The new study is likely to lead to increased understanding of the condition and how it can be avoided.
Learn more about City of Hope's breast cancer research and treatment.