Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial. (June 2022)

• Record Type: Journal Article
• Authors: Appelgren, Matilda; Sackey, Helena; Wengström, Yvonne; Johansson, Karin; Ahlgren, Johan; Andersson, Yvette; Bergkvist, Leif; Frisell, Jan; Lundstedt, Dan; Rydén, Lisa; Sund, Malin; Alkner, Sara; Vrou Offersen, Birgitte; Filtenborg Tvedskov, Tove; Christiansen, Peer; de Boniface, Jana
• Is Part Of: Breast. Volume 63(2022)
• Page Start: 16
• Page End: 23
• Publication Date: 2022-06
• Subjects: Breast cancer -- Patient-reported outcome measures -- Health-related quality of life -- Arm morbidity -- Sentinel lymph node biopsy -- Axillary lymph node dissection; ALND Axillary lymph node dissection -- BCS Breast-conserving surgery -- CTV Clinical target volume -- HRQoL Health-related quality of life -- PROM Patient-reported outcome measure -- RT Radiotherapy -- SLN Sentinel lymph node -- SLNB Sentinel lymph node biopsy; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2022.02.013
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Introduction: This report evaluates whether health related quality of life (HRQoL) and patient-reported arm morbidity one year after axillary surgery are affected by the omission of axillary lymph node dissection (ALND). Methods: The ongoing international non-inferiority SENOMAC trial randomizes clinically node-negative breast cancer patients (T1-T3) with 1–2 sentinel lymph node (SLN) macrometastases to completion ALND or no further axillary surgery. For this analysis, the first 1181 patients enrolled in Sweden and Denmark between March 2015, and June 2019, were eligible. Data extraction from the trial database was on November 2020. This report covers the secondary outcomes of the SENOMAC trial: HRQoL and patient-reported arm morbidity. The EORTC QLQ-C30, EORTC QLQ-BR23 and Lymph-ICF questionnaires were completed in the early postoperative phase and at one-year follow-up. Adjusted one-year mean scores and mean differences between the groups are presented corrected for multiple testing. Results: Overall, 976 questionnaires (501 in the SLN biopsy only group and 475 in the completion ALND group) were analysed, corresponding to a response rate of 82.6%. No significant group differences in overall HRQoL were identified. Participants receiving SLN biopsy only, reported significantly lower symptom scores on the EORTC subscales of pain, arm symptoms and breast symptoms. The Lymph-ICF domain scores of physical function, mental function and mobility activities were significantly in favour of the SLN biopsy only group. Conclusion: One year after surgery, arm morbidity is significantly worse affected by ALND than by SLN biopsy only. The results underline the importance of ongoing attempts to safely de-escalate axillary surgery. Trial registration: The trial was registered at clinicaltrials.gov prior to initiation (https://clinicaltrials.gov/ct2/show/ NCT 02240472). Graphical abstract: Image 1 Highlights: Omission of ALND significantly reduces patient-reported arm morbidity. SLNB versus ALND results in significant less pain and better physical function. HRQoL is not affected by de-escalated axillary surgery. Complaints from axillary surgery are evaluated with patient-reported outcomes.