![]() At a 20 year update of NSABP B-06, , there was no significant difference in outcomes amongst the patients treated with modified radical mastectomy, lumpectomy alone, or lumpectomy with postoperative RT of the breast, with the latter providing strong evidence for using BCT. The treatment of breast cancer has undergone evolution from a radical to a more conservative approach. In addition, wound infection and seroma were recorded by the medical professionals and obtained from the clinic records. Axillary web syndrome (AWS), also known as lymphatic development of tight cords of tissue that extend from the middle of the axilla on the upper surface of the affected arm distally to the antecubital fossa and at times lower, was assessed. Decreased range of motion of the ipsilateral shoulder as compared to the contraletaral shoulder was defined as reduced abduction and measured by the medical professionals. Paresthesia was defined as numbness that was subjectively reported by patients. Arm lymphedema was defined as the difference in the operated arm and the opposite arm by >1cm. Measurements were performed by medical professionals (nursing staff in radiation, medical oncology or surgical oncology clinics) and consisted of objective measurements at baseline and at each follow-up visit in both arms at the antecubital fossa, 10cm superior, 10cm inferior, and at the wrists. ![]() The second assessment was conducted via a clinical examination of the lymphedema. One of which the patient was asked to evaluate the symptom of lymphedema as either present or absent. The forms in the patients charts were filled out by medical professionals at each encounter with the patients. As the vast majority of prospective trials have reported an exceedingly modest follow-up morbidity data, we present one of the longest follow-up studies of complications in the literature to date.Ĭhronic long-term complications are defined as the ones which persist to date at the last follow-up in the evaluable patients. The purpose of this study was to examine and compare the incidences of acute and long-term complications, with the latter available at very mature decade-long follow-up in patients with early stage breast cancer with negative SLN treated BCT and adjuvant breast RT following SLND alone or ALND. Multiple institutions (3,6, 8-11) have published at best a modest follow-up of the rates of these morbidities, as associated with SLND alone and ALND.Įquivalently low failure rates with either SLND or ALND still warrant further evaluation of acute and chronic morbidities associated with each one of these surgical modalities. Long-term side effects may overlap with the acute morbidities and are comprised of such toxicities as lymphedema, decreased ROM of the ipsilateral shoulder, and paresthesia. Amongst the acute, the recognized side effects are axillary web syndrome (AWS), seroma, wound infection, decreased range of motion (ROM) of the ipsilateral shoulder, and change in sensation (paresthesia). Ĭomplications of the axillary surgery are generally known as acute and chronic. A number of investigators have demonstrated that sentinel lymph node dissection (SLND) alone, without further ALND in light of negative axillary sentinel lymph node status, has proven a good alternative to axillary clearance with ALND. While the benefit of axillary lymph node dissection (ALND) as a treatment of choice to reduce the risk of axillary recurrence remained undisputable for years, the risk of considerable morbidity and complications from this therapeutic modality has compelled exploration of other surgical treatment options. ![]() Only 4-7% of patients with negative sentinel nodes (SLN) may harbor occult malignant cells in the remaining axillary lymph nodes (ALN). Breast conserving therapy (BCT) has redefined the approach to breast cancer, with lumpectomy and adjuvant tangential breast radiotherapy (RT) achieving excellent local control rates. Improvement in survival of patients with early stage breast cancer raises concern about minimizing side effects associated with breast cancer therapy. Advances in breast cancer screening and treatment have markedly increased survival rate of patients.
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