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Am Fam Physician. 2000;62(7):1662

The advent of screening mammography and an increased public awareness of breast cancer has resulted in the majority of breast cancer patients being diagnosed in early stages. The incidence rate of positive lymph nodes among patients with breast cancer who have a lesion no larger than 2 cm varies from 5 to 31 percent. Because of this relatively low incidence rate and the morbidity related to axillary lymph node dissection (ALND), routine use of the latter has been questioned. Hoebers and colleagues evaluated the effectiveness and morbidity of primary axillary radiotherapy (ART) in breast-conserving therapy for post-menopausal patients who are clinically axillary lymph node–negative with early-stage breast carcinoma.

The study included 105 patients with clinically negative axillary lymph nodes. All patients were treated surgically with wide local excision followed by radiotherapy (five to six weeks postoperatively) to the breast and axillary and supraclavicular lymph node regions. The patients were followed for an average of 41 months (range: 8 to 137 months) to determine the incidence of treatment failures. In addition to the initial therapy, most patients received tamoxifen in a dosage of 20 mg daily as adjuvant treatment. The patients were also assessed with regard to late functional damage from the radiotherapy.

The mean age of the women was 64. Among the patients enrolled, there were no isolated axillary lymph node recurrences, but three patients developed local recurrence. The five-year disease-free interval rate was 82 percent, and the overall survival rate was 83 percent. Measured arm edema and impaired shoulder motion were reported in 11 and 17 percent of patients, respectively. These rates are significantly lower than the reported rates of arm edema and impaired shoulder motion in patients who received axillary lymph node dissection.

The authors conclude that the recurrence rate for radiotherapy treatment after breast conserving surgery was the same as that in patients who have ANLD. The long-term complication rate was less for radiotherapy. Primary ART should be considered for use in postmenopausal women with early-stage breast cancer who are clinically lymph node–negative.

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