(More) axillary surgery does not influence long-term recurrence

The intensity of axillary surgery in patients with early breast cancer does not influence long-term recurrence, results from an individual patient-data meta-analysis of 30 randomised trials showed.

In early breast cancer, the optimal management of the axilla is uncertain. To better understand the long-term (>10 years follow-up) benefits and risks of different approaches, the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) undertook an individual patient-data meta-analysis of randomised trials, comparing varying types of axillary treatment. Dr Gurdeep Mannu (University of Oxford, UK) presented the results [1].

For this meta-analysis, information was available on 20,273 women in 30 trials of axillary surgery or axillary radiotherapy. The trials took place between 1958 and 2009; median follow-up was 10.0 years (IQR 7.4–11.5). The results were split up for trials in the ‘pre-sentinel lymph node biopsy’ (pre-SLNB) era (1950–1990s) and the ‘sentinel lymph node biopsy’ (SLNB) era (1990s–2010s).

Trials in the pre-SLNB era compared axillary dissection versus no axillary dissection in node-negative disease, axillary radiotherapy versus no axillary radiotherapy, axillary dissection versus axillary radiotherapy, and more versus less axillary surgery. Trials in the SLNB era compared further surgery versus no further surgery in SLN-negative patients, further surgery versus no further surgery in SLN-positive patients, and axillary clearance versus axillary radiotherapy in SLN-positive patients. The majority (25/30) of the recorded trials compared no/less surgery versus (more) surgery.

The meta-analysis showed that there was no difference in 10-year locoregional recurrence, distant recurrence, breast cancer-specific mortality, or any death between less or more surgery. This was the case for both node-negative and (sentinel) node-positive patients, both in the pre-SLNB era and the SLNB era. However, in patients who underwent more surgery, the incidence of lymphoedema was doubled compared with patients with no/less surgery.

In addition, the meta-analysis showed no difference in recurrence or morbidity between axillary dissection versus axillary radiotherapy. However, axillary radiotherapy was associated with less lymphoedema.

Dr Mannu summarised that “more axillary surgery did not reduce recurrence but did increase lymphoedema. In addition, surgery did increase lymphoedema versus radiotherapy.”

1. Mannu GS, et al. Overview of axillary management in early breast cancer. Abstract GS02-05, SABCS 2023, 5–9 December, San Antonio, TX, USA.

 

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Posted on 11 January 202411 January 2024