Gurdeep S. Mannu, DPhil, FRCS, University of Oxford, England, United Kingdom, gave a comprehensive overview of axillary treatment for patients with early breast cancer.

Dr Mannu stated, “we looked at all of the randomized trials that have examined axillary treatment and put the information together to try and identify what the end points of local regional recurrence, distant recurrence, and breast cancer mortality are from different treatments to the axilla.”

These results were first presented at the 2023 San Antonio Breast Cancer Symposium. 

Transcript:

My name is Gurdeep Mannu and I'm a cancer research UK funded clinician scientist. I work as a surgeon and epidemiologist at the University of Oxford and here at the San Antonio Breast Cancer Symposium we'll be presenting our work which is an overview of axillary treatment.

We did an individual patient data meta-analysis of axillary treatment in early breast cancer, and we looked at all of the randomized trials that have examined axillary treatment and put the information together to try and identify what the end points of local regional recurrence, distant recurrence, and breast cancer mortality are from different treatments to the axilla.

We found that there's no evidence of a difference from local regional recurrences, distant recurrence, breast cancer mortality, or all-cause mortality from more, that is less surgery to the axilla, but in the case of isolated axillary recurrences we found that they are quite rare with around 1%, but they do have a reduction for more surgery versus less surgery. That needs to be weighed up with the increase in lymphedema and morbidity that comes with more surgery to the axilla. It's a large effect on a quite a rare outcome so the fact that it doesn't translate into breast cancer mortality means that surgeons need to weigh that up when deciding what treatment is best.

We also compared axillary radiotherapy with axillary surgery, and we found that there was no evidence of a difference in local regional recurrences from axillary radiotherapy with axillary surgery but there were very few events in the longer term to make a robust conclusion. We didn't see any evidence of distant recurrence, breast cancer mortality, or all-cause mortality difference in those randomized to radiotherapy versus axillary surgery. What we did see was an increase in lymphedema from those receiving surgery compared to radiotherapy, albeit from a single trial.

Source:

Mannu G, Beake G, Berry R, et al. Overview of axillary treatment in early breast cancer: Patient-level meta-analysis of long-term outcomes among 20,273 women in 29 randomised trials. Presented at the 2023 San Antonio Breast Cancer Symposium; December 5-9; San Antonio, Texas. Abstract GS02-05