Lymph Node Radiation Therapy Lowers Risk of Metastatic Recurrence

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After surgery to remove early-stage breast cancer, many women will have radiation therapy to the breast area. Radiation is given to reduce the risk of the cancer coming back (recurrence). Breast cancer that comes back in the area where the original cancer was removed is called local recurrence or loco-regional recurrence. Breast cancer that comes back in a part of the body away from the breast (bones, for example) is called distant or metastatic recurrence.

A study has found that women with a higher-than-average risk of breast cancer recurrence were less likely to have local and distant recurrence if they got BOTH whole breast radiation and radiation to nearby lymph nodes (regional lymph node radiation) instead of just whole breast radiation.

The research is published in the Journal of Clinical Oncology and presented at the 2011 annual meeting of the American Society of Clinical Oncology (ASCO).

In this study, 1,832 women diagnosed with early-stage breast cancer were classified as having a higher-than-average risk of recurrence based on characteristics of the cancer. All the women had lumpectomy. During surgery, cancer cells were found in lymph nodes near the breast with cancer in some women, but not others.

After surgery, all the women got chemotherapy and/or hormonal therapy to lower the risk of recurrence. All the women also got one of two standard whole breast radiation therapy regimens. Half the women were randomly chosen to also get regional lymph node radiation.

The researchers compared the outcomes of the women who got whole breast radiation plus regional lymph node radiation to the women who got only whole breast radiation in the 5 years after diagnosis.

Local recurrence was 42% less likely in women who got lymph node radiation compared to women who didn't:

  • 3.2% of women who got lymph node radiation had local recurrence compared to 5.5% of women who didn't get lymph node radiation

The researchers projected that 96.8% of women who got lymph node radiation would be alive with no local recurrence 5 years after diagnosis compared to 94.5% of women who didn't get lymph node radiation.

Distant recurrence was 36% less likely in women who got lymph node radiation compared to women who didn't:

  • 7.6% of women who got lymph node radiation had a distant recurrence compared to 13% of women who didn't

The researchers projected that 92.4% of women who got lymph node radiation would be alive with no distant recurrence 5 years after diagnosis compared to 87% of women who didn't get lymph node radiation.

Lymph node radiation improved disease-free survival and overall survival:

  • The researchers figured out that 89.7% of women who got lymph node radiation would be alive without the cancer coming back anywhere in the body 5 years after diagnosis compared to 84% of women who didn't get lymph node radiation.
  • The researchers figured out that 92.3% of women who got lymph node radiation would be alive whether or not the cancer came back 5 years after diagnosis compared to 90.7% of women who didn't get lymph node radiation.

One possible side effect of breast and lymph node radiation therapy is inflammation in lung tissue that's exposed to the radiation. This is called radiation pneumonitis. Lymphedema, a build-up of lymph fluid in the soft tissue of the arm, trunk, or hand, is also a possible side effect of both breast cancer surgery and lymph node radiation. In this study, both lymphedema and radiation pneumonitis were more likely in women who got lymph node radiation.

Radiation pneumonitis developed in 1.3% of the women who got lymph node radiation compared to 0.2% of women who didn't.

Lymphedema developed in 7.3% of women who got lymph node radiation compared to 4.1% of women who didn't.

The results suggest that both lymph node radiation and whole breast radiation may make sense for some women diagnosed with early-stage breast cancer. This may be especially true for women with cancer that has spread to one or more lymph nodes (node positive) and are considered at high-risk for recurrence.

If you've been diagnosed with early-stage breast cancer, it's a good idea to ask your doctor if the cancer has spread to lymph nodes and talk about what can be done during surgery to treat that. Ask about your risk of recurrence, whether radiation therapy is in your treatment plan, and if lymph node radiation makes sense for your unique situation.

Visit the Breastcancer.org Radiation Therapy section to learn more about the role of radiation therapy in breast cancer treatment, the ways it may be given, and what to expect during treatment.

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