Vergleich der Lebensqualität nach konventioneller Axilladissektion gegenüber der Sentinel-Node-Biopsie bei brusterhaltender Therapie des Mammakarzinoms

Abstract

Almost 57 000 women were diagnosed with breast cancer in Germany in 2004. Breast cancer ist the most common malignant tumor in women. In recent years, there has been a gradual shift based on scientific studies from conventional axillary lymph node dissection to sentinel lymph node biopsy. This gives rise to questions concerning possible improvements in the quality of life of women with breast cancer. OBJECTIVE: The purpose of this study is to compare the quality of life of women with breast cancer after conventional axillary dissection with patients who were treated with sentinel lymph node biopsy. METHODS: 80 women undergoing surgical treatment after a diagnosis of breast cancer between June 2005 and December 2007 in the Alfried Krupp Hospital Essen were analyzed. All women were invited by letter to participate in the interviews which were conducted by telephone. Mean duration of the interviews was 60 minutes. 150 women were invited to take part; 80 of them satisfied the previously defined criteria of the study and agreed to participate, providing written informed consent. 40 women were classified into the axillary lymph node dissection group and 40 women were classified into the sentinel lymph node biopsy group. The interviews were held from July to October 2008. The EORTC QLQ C-30 questionnaire was used as well as the optimized MRP-disease specific questionnaire from 2007 of the German universities Marburg and Regensburg. RESULTS: Average age of the women in the axillary dissection group was 57.55 ± 12 years, significantly lower than the average age in the sentinel lymph node biopsy group. The primary tumor size was comparable in both groups and showed no measurable difference. All women received postoperative radiation therapy. Six patients in the sentinel group received adjuvant chemotherapy. In the axillary lymph node dissection group, four patients received neoadjuvant chemotherapy and 28 women were given adjuvant chemotherapy. This difference was statistically significant. There were no statistically significant differences between groups with regard to postsurgery pain, wound healing disturbance, bodily and psychological recovery, cosmetic results, insomnia, motion-dependent pain, limitation of arm motion, difficulties at home, limitations with regard to hobbies and sports activities, swelling of the arm, hand or breast, sensory disturbance and skin problems of the operated breast, contact to self-help groups, problems with their partner, and sexual activity. Statistically significant differences between the analyzed groups were found with regard to chronic postoperative pain, sensory disturbance and disturbance in the muscular power of the arm and shoulder, number of treatments, pain in the affected breast and individual concerns about their health. CONCLUSION: Six sections of the questionnaire showed a significantly better quality of life for women in the sentinel lymph node biopsy group compared with women in the axillary lymph node dissection group. While some of the sections showed no statistically significant difference, they still demonstrated a trend towards a better quality of life as subjectively experienced by the patients in the sentinel lymph node biopsy group. However, prior to the study, it was thought that the difference in quality of life in the sentinel lymph node group compared with the axillary dissection group would be even higher; that this was not the case may be due to the limited number of analyzed cases and the short time period between surgery and interview. Moreover, although the two groups were highly sensitive and were analyzed on the basis of many different parameters, axillary lymph node dissection is a mature procedure perfected over many years. Axillary lymph node dissection was compared with sentinel lymph node biopsy, a relatively new approach where the learning curve may not yet have peaked. Higher numbers of patients and prospective studies are indicated.