The American Clinical Oncology Society (ASCO) Congress gathers each year leading cancer experts. Present in Chicago in July 2010, PR. Pierre Fumoleau, Director General of Centre of fight against the Cancer Georges-François Leclerc (Dijon) presents the main advanced breast cancer.
Doctissimo: Several studies presented at the 2010 Convention of the American Cancer Society are interested in the technique of Sentinel lymph node. Can you in the preamble explain the principle of this surgery?
PR. Pierre Fumoleau: Invasion of the lymph nodes in the armpits is the first step towards the development of metastases in breast cancer. To avoid it, the removal of invasive tumour of the breast (i.e. having started to infiltrate the mammary gland) has long associated in an axillary dissection of the side reaches (removal of the lymph node chain).
Developed in the 1990s Sentinel node technique will take the first lymph to review and not practicing clean, if these first ganglia are “met”, if they contain malignant cells. This less traumatic method limits including Lymphedema issues or “big arm”.
Doctissimo: This technique less traumatic is as effective as an axillary dissection?
PR. Pierre Fumoleau: Several studies have compared ganglion Sentinel + cleaning systematic versus ganglion Sentinel and if necessary cleaning. Most have found comparable effectiveness between the two techniques1. The results of the largest clinical trial known as NSABP 32 were presented at the Congress of the ASCO 20102. Involving more than 5,600 women for more than 8 years, this study was not observed difference between the two techniques in terms of overall survival (number of women who have survived the end of the study), survival without progression of the disease or recurrence of cancer. These results thus confirm the interest of the technique of the Sentinel lymph node, less traumatic for patients.
Doctissimo: If Sentinel lymph node are met, a drain is therefore normally made. But this procedure is called into question by a U.S. study for small tumors…
PR. Pierre Fumoleau: When the tumor is less than 5 cm and that there is no evidence of spread of the disease outside breast, axillary dissection is necessary even if the Sentinel nodes are met? No, according to a U.S. study3 891 women followed for nearly 6 years. In other words, if the tumor is small, and even if the Sentinel nodes are positive, the authors believe that it is not useful to remove other ganglia, because there was no difference in overall survival or recurrence of cancer.
Doctissimo: Is it the end of the axillary dissection for these small tumors?
PR. Pierre Fumoleau: No, because despite its quality, this study has some limitations. On the one hand, the number of women participating remains limited (450 women in each group). On the other hand, follow-up is 6 years, or known that late recurrences can occur beyond this period. A confirmation by another study will be necessary before the practices change in this area.