This international clinical trial investigated whether avoiding axillary surgery in older women would result in improved quality of life with similar disease-free survival and overall survival. Axillary clearance in early breast cancer aims to improve locoregional control (control of cancer in the breast and armpit) and provide staging information but is associated with undesirable side effects.
IBCSG 10-93 Surgical therapy with or without axillary node clearance for breast cancer in older patients who receive adjuvant therapy with tamoxifen.
The incidence of breast cancer increases with age and breast cancer is the most common cancer in women older than 70 years old. Given that populations are aging, increasing numbers of breast cancer occurrences can be expected among older women.
The development of medical conditions also increases with age. Because some medical conditions may limit the duration and extent of a surgical procedure, there is a potential advantage to avoiding axillary surgery if it does not compromise tumor control. Avoiding axillary surgery may also reduce postoperative effects on arm pain, mobility, and lymphoedema.
Avoiding axillary clearance for women 60 years or older (median age 74 years in both treatment arms); who have clinically node-negative disease and who receive tamoxifen; results in similar efficacy with better early quality of life.
Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10-93.
Rudenstam CM, Zahrieh D, Forbes JF, Crivellari D, Holmberg SB, Rey P, Dent D, Campbell I, Bernhard J, Price KN, Castiglione-Gertsch M, Goldhirsch A, Gelber RD, Coates AS, for the International Breast Cancer Study Group. J Clin Oncol 2006; 24(3):337-344.