Surgical oncologist Hanh-Tam Tran explains the importance of lymph node surgery and how axillary sampling is evolving in the breast cancer setting for patients aged 70 years and over.
Okay, okay, patients diagnosed with breast cancer routinely require some type of lymph node sampling. Lymph node sampling provides prognostic information to tailor adjuvant treatment I. E. Chemotherapy or further axillary surgery, explore a lymph node dissection itself does not affect the patient's overall survival. It used to be that if patients with breast cancer involving lymph nodes that would require chemotherapy and an excellent lymph node dissection with newer data, we're finding that in patients with metastatic disease to the lymph nodes adding chemotherapy and or axillary dissection does not improve overall survival. Nor does it decrease local recurrence rates for select patients with early stage estrogen positive breast cancers. We can send an archetype which looks at the genetic sequence of the cancer and predict whether or not the cancer is chemo sensitive. If the results show a low recurrence score then the cancer is unlikely to recur and the addition of chemotherapy is not indicated. Thus the patient could be recommended only hormone blocking treatment. The uncle type has also been studied in patients with low nodal disease burden and are prognostic of outcome in terms of axillary management fizzy 11 studies showed that in patients with cancer is less than five centimeters and hormone positive Patients with 1-2 positive lymph nodes can have a mission of axillary lymph node dissection and it is replaced with ac slater radiation. The study shows that there was no statistical significant difference in overall survival or local recurrence rates between axillary lymph node dissection or Axler radiation. The benefit of axillary radiation is that the morbidity associated with it is much lower compared to an axillary lymph node dissection, mm hmm. Yeah. No. What we have found is that in patients greater than 70 years old with small breast cancers we can safely omit lymph node sampling in these patients. In 2013, a retro respective review of the C A l g b 93 43 patient population Found that patients who was greater than 70 years old having cancer less than two cm and hormone positive and plan on taking endocrine treatment, 63% of those patients did not get axillary surgery. There were no difference in overall survival compared to patients who did have axillary surgery. The local recurrence rate was higher by 3% compared to those getting axillary dissection. Using this information. The choosing wisely campaign recommends that it is safe to omit axillary surgery and patients greater than 70 years old with an early stage hormone positive breast cancer. Yeah.
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