Abstract
Purpose
To determine whether the benefits of sentinel node based management (SNBM) over routine axillary clearance (RAC) at 1 year persisted to 3 years of follow-up.
Methods
A total of 1,088 women with clinically node-negative breast cancer were randomly assigned to the SNBM or RAC group. Upper limb volume, symptoms, and function were assessed at 1, 6, 12, 24, and 36 months after surgery objectively with upper limb measurements by clinicians and subjectively by patients’ using validated self-rating scales.
Results
Upper limb volume increased in both groups over the first 2 years and differed between the two groups all time points beyond 1 month (P < 0.02) but then plateaued. Upper limb swelling was no worse in women who had axillary clearance as a two-stage procedure than in women assigned RAC as a one-stage procedure. Upper limb volume had increased 15 % or more in 6.0 % at 6 months and 17.6 % at 3 years in those assigned RAC versus 4.2 and 11.9 % in those assigned SNBM. Reductions in upper limb movement were also greater, with RAC than SNBM over 6 months, but improved and were similar in the two groups from 1 to 3 years. Subjective ratings of upper limb swelling, symptoms, dysfunction, and disability over 3 years were worse in the RAC group. Upper limb swelling at 3 years was rated severe by few women (1.1 %) but was rated as moderate by 9.4 % in the RAC group and 2.5 % in the SNBM group (P < 0.001).
Conclusions
The benefits of SNBM over RAC persist 3 years after surgery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gill PG, Wetzig N, Gebski V, et al; SNAC Trial Group. Sentinel-lymph-node-based management or routine axillary clearance? One-year outcomes of sentinel node biopsy versus axillary clearance (SNAC): a randomized controlled surgical trial. Ann Surg Oncol. 2009;16:266–75.
Tewari N, Gill PG, Bochner M, Kollias J. Comparison of volume displacement versus circumferential upper limb measurements for lymphoedema: implications for the SNAC trial. ANZ J Surg. 2008;78:889–93.
Smith MJ, Gill PG, Wetzig N, et al; Royal Australasian College of Surgeons SNAC Trial Group. Comparing patients’ and clinicians’ assessment of outcomes in a randomised trial of sentinel node biopsy for breast cancer (the RACS SNAC trial). Breast Cancer Res Treat. 2009;117:99–109.
Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst. 2001;93:96–111.
Kell MR, Burke JP, Barry M, Morrow M. Outcome of axillary staging in early breast cancer: a meta-analysis. Breast Cancer Res Treat. 2010;120:441–7.
Land SR, Kopec JA, Julian TB, et al. Patient-reported outcomes in sentinel node-negative adjuvant breast cancer patients receiving sentinel-node biopsy or axillary dissection: national surgical adjuvant breast and bowel project phase III protocol B-32. J Clin Oncol. 2010;28:3929–36.
Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98:599–609.
Krag D, Anderson SJ, Julian TB, et all. Sentinel lymph node resection compared with conventional axillary lymph node dissectionin clinically node negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33.
Fleissig A, Fallowfield L, Langridge CI, et al. Post-operative upper limb morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary dissection in management of patients with early breast cancer. Breast Cancer Res Treat. 2006;95:279–93.
Haddad P, Farzin M, Amouzegar-Hashemi F, et al. A multicentre cross-sectional study of arm lymphedema four or more years after breast cancer treatment in Iranian patients. Breast Cancer. 2010;17:281–5.
Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92:1368–77.
Goyal A, Newcombe RG, Chhabra A, Mansel RE. Morbidity in breast cancer patients with sentinel node metastases undergoing delayed axillary lymph node dissection (ALND) compared with immediate ALND. Ann Surg Oncol. 2008;15:262–7.
Acknowledgment
The SNAC trial was funded by Grants from the National Health and Medical Research Council (NHMRC), the National Breast Cancer Foundation, the Australian Department of Health and Ageing, MBF Australia, and the Scottwood Trust, New Zealand. The study was conducted independently of the funders by the management committee—P. G. Gill (study chair), N. Wetzig (deputy study chair), M. Bilous, I. Campbell, J. Collins, X. Coskinas, G. Farshid, V. Gebski, D. Gillett, W. Hague, R. Harman, J. Kollias, A. Macphee, R. J. Simes, M. Stockler, O. Ung, R. Uren, B. Vachan, L. Young—and coordinated at the NHMRC Clinical Trials Centre. Rhana Pike, from the Clinical Trials Centre, assisted with article preparation.
Disclosure
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
On behalf of the SNAC Trial Group of the Royal Australasian College of Surgeons and NHMRC Clinical Trials Centre.
Trial registration: ACTRN12605000357651.
Rights and permissions
About this article
Cite this article
Wetzig, N., Gill, P.G., Zannino, D. et al. Sentinel Lymph Node Based Management or Routine Axillary Clearance? Three-year Outcomes of the RACS Sentinel Node Biopsy Versus Axillary Clearance (SNAC) 1 Trial. Ann Surg Oncol 22, 17–23 (2015). https://doi.org/10.1245/s10434-014-3928-7
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-014-3928-7