Long term results of treatment of breast cancer without axillary surgery – Predicting a SOUND approach?. Issue 7 (July 2016) - O'Connell, R.L.
Abstract: Background: Traditionally axillary surgery has been used to provide staging information and until recently was thought to improve loco-regional control. However, a more minimal approach to the axilla is now being adopted. The aim of this study was to assess long term outcomes of patients with 'low-risk' breast cancers who did not undergo any axillary surgery. 'Low-risk' criteria were: postmenopausal, <20 mm grade 1 or <15 mm grade 2, LVI-ve, ER +ve. Methods: Women with invasive breast cancer that did not undergo any axillary surgery were identified. Patients were censored when an event or death occurred or at last follow-up at breast clinic or with their General Practitioner. Results: Between 05/01/1995–20/11/2006, 194 patients (199 tumours) were operated upon without axillary surgery. Median follow-up was 10.4 years. 128 patients met low-risk criteria and 71 did not (patient choice = 42, medical fitness = 29). In the 'low risk' cohort there were two axillary recurrences, with a cumulative incidence of 0.8% and 1.9% at 5 and 10 years respectively. DDFS was 99.2% (94.1–99.9%), and 97% (90.0–99%) at 5 and 10 years respectively and DFS was 96.6% (91.1–98.7%) and 91.2% (82.6–95.6%). OS was 90.3% (95% CI: 83.6–94.4) and 75.5% (95% CI: 65.9–82.8) at 5 and 10 years respectively. Conclusion: Axillary recurrence and DDFS in this low-risk cohort is favourable. In the modern era of breast cancer management it is possible to define a group of women in whom axillary surgery can be omitted. Abstract : Even with long-term follow-up, axillary recurrences are rare in carefully selected patients who do not undergo axillary surgery. Overall survival in these patients is comparable with those who do.