Research indicates new techniques could make breast cancer surgery less traumatic

Monday, October 22nd 2001, 12:00 am
By: News On 6

LISBON, Portugal (AP) _ New surgical techniques could save the lymph nodes and avoid radiotherapy after breast cancer surgery, a leading expert said Monday.

Traditional breast surgery involves removing all the lymph glands in the armpit to determine if the tumor has spread. Most of the time in early breast cancer, it has not. However, about 20 percent of women then suffer the rest of their lives from swelling in their arms, which can painfully balloon to twice the normal size and leave them disabled and prone to infections.

Dr. Umberto Veronesi, a pioneer of breast conserving surgery in the 1970s, presented new evidence at a meeting of the Federation of European Cancer Societies that indicated that first removing only one key node for testing was as accurate a predictor as cutting them all out.

The technique, known as sentinel node biopsy, is rapidly gaining recognition and is used quite widely in top cancer centers, but has not been embraced by all cancer doctors.

``It's a little controversial. Certain opinion leaders feel it's not totally established yet,'' said Dr. Larry Norton, chief of medical oncology at Memorial Sloan-Kettering Cancer Center in New York City.

Although he follows Veronesi's approach with his patients, Norton said more research is needed before the technique becomes universally accepted.

Dr. Harry Bartelink of the Netherlands Cancer Institute, also took a cautious view.

``Breast cancer is a slow, recurrent disease, so I would really like to see 10 years of follow-up to say it's safe,'' he said. ``It would be better to remove all the nodes than the wrong one.''

The status of the lymph glands is considered one of the most important indicators of prognosis and which treatment is best.

``But we are convinced that if you remove healthy lymph nodes, first of all it's an unnecessary operation which has side effects and perhaps as these lymph nodes are immunologically active cells, it might even be dangerous,'' Veronesi said.

There are between 25 and 40 lymph nodes under each armpit and the location of the sentinel node _ the first node to be invaded by cancer _ varies from woman to woman.

To find the right node, a radioactive probe is injected into the breast, close to the tumor, and is carried by the lymphatic system into the sentinel node. The glow of the tracer guides surgeons to the correct node.

Doctors then remove the tagged node and tests establish whether cancer is present and thus if removal of the rest of the lymph nodes and further treatment are necessary.

Veronesi said his institute offers the technique to all its breast cancer patients. So far 2,500 women have undergone the procedure since it was introduced six years ago.

In his new study, 516 breast cancer patients got either a lumpectomy and total lymph node removal, or the tumor cut out of their breast and only the sentinel node extracted. There were 257 women in each group.

In cases where the sentinel node showed cancer, the rest of the nodes in the armpit were cut out.

The cancer had spread to the lymph nodes in 35 percent of the women who had all their lymph nodes removed, and in the same proportion of those who had only the sentinel node cut out.

In the four years since the surgery, the lymph nodes of all 167 women whose sentinel nodes were clear have remained cancer free.

As well as minimizing the lymph node surgery, Veronesi is also researching whether the trauma of radiotherapy after surgery can be avoided by delivering a single radiation dose during surgery directly into the area where the tumor has been removed.

About 90 percent of breast cancer recurrences happen at the site of the original tumor, he said.

The single dose is equivalent to that of a full course of standard external radiation therapy to the whole breast.

``I think that's an extremely exciting approach that needs to be evaluated,'' Norton said. ``Veronesi has always been ahead of the rest of the world in terms of innovative ideas and if this turns out to be true, it would make a huge difference to patients' quality of life.''

Veronesi envisions one day treating breast cancer in a single operation.

``In one hour, or two hours, the patient will have removal of the tumor, the sentinel node biopsy ... and a single full-dose of radiation to the breast,'' he told doctors. ``I think it might be considered a breakthrough. If these two new procedures prove effective, then we can present breast cancer to women with a more optimistic view.''