Miguel Bronchud, Co-Founder at Regenerative Medicine Solutions, shared a post on LinkedIn:ս
“Axillary lymph nodes in breast cancer- causing further metastatic spread? or ՛vaccinating patients against՛ it? Or both?
The non-inferiority SENOMAC trial has confirmed that omitting completion axillary lymph node dissection (ALND) is oncologically safe (ie, a less intensive approach does not compromise outcomes) and substantially reduces patient-reported arm morbidity in patients with one or two sentinel lymph node macrometastases-including patients with T2–T3 tumors and those undergoing mastectomy, Swedish investigators reported at the 2026 ASCO Annual Meeting: omission of completion axillary lymph node dissection should be the standard of care in breast cancer that has spread to only one to two sentinel lymph nodes.
ALND has long been standard practice following a positive sentinel lymph node biopsy in breast cancer; however, ALND carries significant risks of arm-related morbidity, including lymphedema, reduced range of motion, and chronic pain. Earlier trials, notably ACOSOG Z0011, suggested that ALND could be safely omitted in select patients but were limited by their focus on breast-conserving surgery and smaller tumors (< 5 cm).
This new study enrolled patients with larger tumors (T3, albeit only 5.8% of patients) and those undergoing mastectomy (36%, c900 patients)-populations previously excluded from trials. In the group having completion ALND, additional cancer was found in the lymph nodes in 34.5%.
Final nodal stage was pN1 for the vast majority of patients in both groups but was reported as pN2-3 for 12.5% of the completion ALND group compared to 0.5% of the omission group.
One sentinel node macrometastasis was identified in 84.6%. Additional sentinel node micrometastases were found in 10.2% of these patients. For the ALND and omission groups, respectively, regional recurrences were observed in 0.6% and 0.7% and distant recurrences in 5.5% and 4.9%. The findings were consistent across subgroups.
So why does metastatic cancer in the axillary lymph nodes of at least some 10% of patients (not undergoing ALND) not cause further metastatic spread or local recurrence?
Is this because these residual cancer cells are controlled by the radiotherapy, chemotherapy and endocrine therapies all patients received? Or because an unknown % of the residual cancer cells are presumably controlled by the immune cells of the same lymph nodes?”
Title: Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis – The ACOSOG Z0011 (Alliance) Randomized Clinical Trial
Authors: Armando E. Giuliano, Karla V. Ballman, Linda McCall, Peter D. Beitsch, Meghan B. Brennan, Pond R. Kelemen, David W. Ollila, Nora M. Hansen, Pat W. Whitworth, Peter W. Blumencranz, A. Marilyn Leitch, Sukamal Saha, Kelly K. Hunt, Monica Morrow
Read the Full Article.
You can also read:
