One of the most feared side effects of breast cancer treatment – lifelong swelling in the arm – could be avoided with a new treatment approach.
Patients would still have surgery to remove the cancer, but instead of cutting out small glands under the arm as is currently the standard approach, doctors could treat the area with radiotherapy.
Removing these glands can damage the body’s natural drainage system, causing fluid to build up and the arm to swell – a condition known as lymphoedema.
By leaving them in place and treating them with radiation instead, that risk is much lower.
Around one in five breast cancer patients develop lymphoedema after treatment. The risk rises to as many as one in two in those who have the glands removed.
Now, a study suggests radiotherapy could offer a safer alternative.
Research presented at the European Breast Cancer Conference in Barcelona compared patients who had the glands removed with those who received radiotherapy instead.
The trial followed more than 270 people whose cancer had spread to nearby glands.
Lymphoedema is a long-term, incurable condition that causes swelling in the body’s tissues
After two years, lymphoedema developed in just under 18 per cent of those given radiotherapy, compared with more than 26 per cent of those who had surgery.
Cancer outcomes were similar in both groups, with no recurrences in the radiotherapy group and one in the surgery group.
Professor Amparo Garcia-Tejedor, from Bellvitge University Hospital and lead author of the study, said the findings could change how patients are treated.
‘If the study confirms the safety and effectiveness of radiotherapy instead of surgery, the implications for both patients and clinicians could be substantial,’ she said.
‘For patients, the main benefit would be an improvement in quality of life.’
She added that treatment has already moved away from aggressive surgery over time.
‘Now, the goal is to save lives without increasing adverse effects. Our findings suggest that surgery may be unnecessary in a substantial proportion of patients and that a strategy of de-escalation should be explored,’ she said.
Experts cautioned that patients should not change treatment based on these early findings alone, with a larger phase III trial ongoing.
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Should doctors risk new side effects to spare breast cancer patients from lifelong arm swelling?
Around one in seven women will develop breast cancer in their lifetime. However researchers found that patients treated with radiotherapy were significantly less likely to develop lymphoedema
Dr Maria Laplana-Torres, a radiation oncologist involved in the study, said radiotherapy caused more short-term skin side effects, such as redness and peeling, but these were usually temporary.
After two years, there were no major differences in movement or overall quality of life between the two groups, although outcomes slightly favoured radiotherapy.
More than 500 patients have now joined the main trial, with results expected after around three more years of follow-up.
Dr Simon Vincent, chief scientific officer at Breast Cancer Now, who was not involved in the research, welcomed the findings but urged caution.
‘While this early research suggests that radiotherapy may be a suitable alternative treatment to avoid unwanted side effects like lymphoedema, we hope to see longer follow-up of patients to fully understand its safety and effectiveness,’ he said.
Lymphoedema affects more than 200,000 people in the UK, most commonly as a result of cancer treatment.
Breast cancer is the most common cancer in women in the UK, with around 55,000 new cases each year.
