May 2006 Edition
This Lymphedema eNews is being generated through your request from our website.
Sentinel node biopsy: Is axillary dissection required even if the lymph nodes are positive?
In previous eNews editions I have discussed the value of sentinel node biopsy in the assessment of spread of breast cancer. In these reviews, I discussed the fact that sentinel node biopsy could replace axillary dissection as a method to determine the extent of cancer involvement at the time of diagnosis. Among patients without evidence of cancer in the nodes, axillary dissection could be avoided. By avoiding axillary dissection, many women could reduce the risk of lymphedema.
In this edition of eNews, I would like to discuss new findings on the optimal management of patients who are found to have cancer in the lymph nodes at the time of sentinel node biopsy. The current standard of treatment for patients with positive nodes on sentinel node biopsy is to undergo complete surgical dissection of the axillary nodes. Axillary dissection is indicated because it reduces the chance that breast cancer will recur. However, the complications of the surgery are significant. About 20% of wo men who undergo axillary dissection develop lymphedema, 10% have chronic pain and 10% have limitations in the range of motion of their arms on the side treated with surgery.
Dr. Michele Gadd MD at Harvard Medical School evaluated the benefit of giving chemotherapy along with radiation to the involved axilla to patients with positive lymph nodes following sentinel node biopsy. The data from this study was presented at the recent San Antonio Breast Cancer Symposium. A total of 560 women with early stage breast cancer were studied. Among this group, women with evidence of lymph node involvement received radiation to the axillary region. Of the 560 women studied, 117 had positive sentinel node biopsies and 77 were evaluated for the relative benefit of radiation and chemotherapy for treatment of positive sentinel nodes. These patients were enrolled in this study starting in January of 2000 and enrollment into the study was completed in February of 2004. At the time of analysis of the data, some women were on the study for about 5 years while other were on for less than 1 year. The average time on the study was about 3 years. Among these patients, only 1 of 77 patients studied had a recurrence of cancer in the axilla. This person then underwent axillary dissection and was out about 2 years from the axillary dissection without evidence of metastatic disease. Three additional patients developed metastatic disease with evidence of cancer elsewhere in their body.
This study indicates that even among patients with positive sentinel node biopsies, treatment with chemotherapy and radiation may provide good control of the cancer in the axillary region without the need for surgery. The authors of this study stressed that additional studies are needed to clearly demonstrate that effective control of cancer in the lymph nodes is achieved with radiation instead of surgery. Furthermore, larger studies will be needed to determine the risk of lymphedema among these patients r eceiving only chemotherapy and radiation compared to those receiving axillary dissection. However, the results of this study are very promising and many women even with positive nodes after sentinel node biopsy may be candidates for radiation therapy rather than surgery.
Tony Reid MD Ph.D
The OptiFlow® RM Lower Extremity
The long anticipated release of the OptiFlow RM for the lower extremity is now available.
Patients have reported increased comfort and more consistent compression, while gaining the proven advantages of the high and low pressure points of the Tissue Gradient Technology. This patented design provides variable tissue pressure, while maximizing compression, softening tissue, and minimizing the obstruction of normal lymphatic and venous flow.
Bandages and wraps can be very useful, but do have some limitations. First, bandages and wraps are often difficult to apply properly and consistently. Second, the pressure applied may encircle, constrict, and/or obstruct normal lymphatic and venous flow. The OptiFlow RM helps overcome to these problems. This unique system provides effective and comfortable compression therapy for lymphedema patients.
The OptiFlow RM is a lightweight, cooler and slimmer garment than the ReidSleeve Classic. It is an ideal option for patients with mild to moderate lymphedema.
The OptiFlow RM is also an effective complement to Complex Decongestive Therapy (CDT). The OptiFlow RM can help the patient effectively maintain their edema reduction achieved through CDT.
ReidSleeve® Classic Approved for Ontario, Canada
We are extremely happy to announce that the Adaptive Device Program (ADP) in Ontario, Canada has now approved the ReidSleeve Classic (upper and lower extremity). Patients who are covered under ADP (in Ontario) can now go to an authorized distributor and have this product covered if they meet the eligibility criteria.