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Pioneering breast cancer trial gets underway

A pioneering research trial which could change the way breast cancer is detected and treated across the country will get underway in the region this month.

Patients are now being recruited for the 'Multidetector Computed Tomography Improving Surgical Outcomes in Breast Cancer (MISO BC)' trial which is being led by County Durham and Darlington NHS Foundation Trust , with academic partners from the Wolfson Research Institute, Durham University.

The study will investigate whether multidetector CT scanning can be used to accurately assess whether breast cancer has spread from the breast to the lymph nodes (cells) in the arm pit (axilla).

The Chief Investigator of the trial is Dr Julie Cox, a Consultant Radiologist at University Hospital North Durham. Dr Cox said: "This is an exciting trial which, depending on the outcome, has the potential to change clinical practice nationally."

"If we find that a CT scan is useful in assessing whether the cancer has spread then it will mean that more patients are able to get the best surgical treatment for their condition the first time, reducing the distress and complications that go with additional surgery with second operations.

"The usual practice in the UK is to remove the lymph nodes in the axilla to see whether they are involved with cancerous cells via a procedure called a sentinel lymph node biopsy (SLNB). If they are involved, then further treatment is generally required. This treatment usually involves a procedure to completely remove the lymph nodes, called an axillary lymph node dissection (ALND) or sometimes axillary radiotherapy.

"Both ALND and radiotherapy to the axilla have complications with risks of lymphoedema or swelling of the arm. This is difficult to treat in up to 20% of patients.

"In around 25% of patients, the sentinel lymph node will contain tumour cells which will mean the surgeon has to re-operate and perform a full axillary lymph node dissection.

"By using the latest multidetector CT scanning technology, we propose that by  carefully looking at the the lymph nodes in the armpit we will be able to learn more about the spread of the cancer  at an earlier stage and therefore would hope to reduce the need for a second operation."

The study takes the form of a trial where patients with breast cancer are randomised in equal numbers to one of two groups.

One group will have a CT scan of their arm pit on the same side as the breast cancer. This is because this is usually the first site that breast cancer cells spread to before they spread throughout the body. The other group will receive routine diagnostic and surgical care.

It is hoped to recruit 300 patients over the next two years. Once the trial has been completed a detailed statistical analysis will be carried out on the results by Durham University. A successful outcome would see a reduction in the re-operation rate.

The study has been funded by the National Institute for Health Research.

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