Email updates

Keep up to date with the latest news and content from WJSO and BioMed Central.

Open Access Highly Accessed Review

Axillary treatment for patients with early breast cancer and lymph node metastasis: systematic review protocol

Amit Goyal1*, Lelia Duley2 and Apostolos Fakis3

Author Affiliations

1 Department of Surgery, Royal Derby Hospital, Derby, England

2 Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, England

3 Research & Development Department, Royal Derby Hospital, Derby, England

For all author emails, please log on.

World Journal of Surgical Oncology 2013, 11:6  doi:10.1186/1477-7819-11-6

Published: 14 January 2013

Abstract

Background

For patients with early breast cancer and lymph node metastasis, axillary treatment is widely recommended. This is either surgical removal of the axillary lymph nodes, or axillary radiotherapy. The rationale for axillary treatment is that it will reduce the risk of recurrence in the axilla, and may improve survival. However, both treatments are associated with adverse effects, such as lymphedema, pain and sensory loss, and are costly to the health services and to patients. With improvements in adjuvant therapy, routine axillary treatment may no longer offer any overall advantage.

Objectives

To assess the short and long term benefits and adverse effects of routine axillary treatment (axillary lymph node clearance or axillary radiotherapy) for patients with lymph node positive early-stage breast cancer.

Methods/Design

Criteria for potentially eligibility for the study will be that the participants are men and women with early breast cancer and lymph nodes with metastasis. The study compares either axillary treatment with no axillary treatment, or axillary node clearance with axillary radiotherapy, and the study is a randomized trial. Primary outcomes are axillary recurrence, disease-free and overall survival. Secondary outcomes include breast or chest wall recurrence, distant metastasis, time to axillary recurrence, axillary recurrence-free survival, arm morbidity, quality of life and health economic costs. The search strategy will include the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and WHO International Clinical Trials Registry Platform (ICTRP) search portal. Two independent reviewers will assess studies for inclusion in the review, assess study quality and extract data. Characteristics of included studies will be described. Meta-analysis will be conducted using ReVman software.

Comment

This review addresses an important clinical question, and results will inform clinical practice and health care policy.