OUTCOME IN BREAST-CANCER MANAGED WITHOUT AN INITIAL AXILLARY LYMPH-NODE DISSECTION

Purpose: The role of an elective axillary lymph node dissection (AxLND ) in the initial management of patients with early stage breast cancer has recently become controversial. The objective of this current stud y is to review the reasons as to why patients from a single institutio n were managed without an initial AxLND and their outcome in terms of survival and recurrence rates. Materials and methods: A retrospective analysis was conducted on 126 women referred to the Princess Margaret Hospital with the diagnosis of breast cancer who did not undergo an in itial AxLND. Results: The median age nf this population was 69 years w ith thp vast majority (93%) being post-menopausal. Fifty-seven patient s had T-1 tumors and the remainder had T2-3 tumors. Adjuvant radiation therapy to the breast was administered to 65 patients and systemic ad juvant treatment was administered to 24 patients. In approximately one -third of these cases, the reasons cited for not performing an AxLND w ere related to the patient's age, a medical contraindication, or the p atient's choice, The 5-year actuarial cause-specific survival was 92%; the local breast relapse-free rate (RFR) was 85% and the axillary RFR was 86%. No patients in this study experienced debilitating symptoms from their axillary disease. Only 16 patients underwent a subsequent A xLND, with the lymph nodes being pathologically uninvolved in six of t hese patients. Conclusion: This study supports the concept that, in se lected patients, adopting nn approach nf a delayed AxLND does not appe ar to compromise the patients' outcome, with only 13% of patients requ iring a subsequent AxLND. (C) 1998 Elsevier Science Ireland Ltd. All r ights reserved.