POSNOC Trial? Pros V Cons, will Chemo kill lymph Nodes without surgery first?

Hello All,

 just had DCIS surgery and they removed 3 lymph nodes as well. One had the cancer cell. So was offered the POSNOC trial or to have my L.N’s removed and the chemo and radiotherapy…But

Do I risk lymphedema if I have them removed? Or

is chemotherapy so advanced now as the POSNOC Trial people are saying that I don’t need the surgery, just the chemo and radiotherapy? 

So confused. The more I look for answers the more questions come up.

thank you in advance for any answers.




 Hi star girl


I had the same as you back late December.  3 nodes removedand lumpectomy, they found 2 nodes had cells in so they advised me to have lymph clearance and have them all removed to make sure. I have not got lymph oedema, but I do have a Sedona u dear my arm pit. I am now awaiting to hear what is next for me. I can’t advise you but for the future I am glad I have had them removed, I never want this back!!! 


Let eat me know what you decide and good luck with it, hope all goes well for you.




I think the reason the UK is running the POSNOC trial is because the USA ran a similar one (in (2011) and their methods are changing due to this. It is now standard in the USA not to routinely remove lymph nodes if one is found with cancer and the patient is having the appropriate chemo, rads etc.


My surgery was in November and I was faced with a similar decision but the other way around.


As my lump was large and in a difficult place my Oncologist suggested on diagnosis, that I start with chemo and then have a lumpectomy if it shrank enough. I also had a lymph node positive.


The chemo really did the trick for me. My lump shrunk away to almost nothing and so I decided to have a Lymph node biopsy rather than a removal. There was no cancer found in the nodes in the end.


Partly, I made that decision based on the USA research that showed for women with one positive lymph node the survival rate was about the same as woman with no node involvement, who had chemo and rads (i.e. I didn’t need my lymph nodes removed). 


Here’s a snip from about the USA research in 2011 (similar to POSNOC)



Subsequently, the American College of Surgeons Oncology Group, which is another NCI clinical trials cooperative group, reported findings from an additional phase III clinical trial, this one testing whether women with a positive sentinel lymph node but no clinical evidence of axillary lymph node metastasis could be safely treated with tumor removal and no further lymph node surgery other than the SLNB (3). In this trial, 891 women were randomly assigned to SLNB only or ALND after SLNB (3). All of the women were treated with lumpectomy. More than 95 percent of them also received adjuvant systemic therapy (chemotherapy, hormone therapy, or both), and about 90 percent received external-beam radiation therapy to the affected breast.


When the results of this trial were reported, the patients had been followed for a median of 6.3 years. The two groups of women had similar 5-year overall survival (92.5 percent in the SLNB-only group versus 91.8 percent in the SLNB plus ALND group) and 5-year disease-free survival (83.9 percent in the SLNB-only group and 82.2 percent in the SLNB plus ALND group). The researchers concluded that SLNB alone is safe and does not affect the survival of women who have sentinel lymph node metastasis but no clinical signs of other lymph node involvement and whose breast cancer is treated with surgery, systemic therapy, and external-beam radiation therapy. The excellent outcome in this trial for women treated with SLNB without ALND is likely due, at least in part, to the ability of local radiation therapy and modern systemic treatments to effectively treat breast cancer cells that may have spread to other axillary lymph nodes besides the sentinel node or to other parts of the body.





 I didn’t go for the POSNOC Trial.  I had the Axillary Clearance on Thursday at 9am and was discharged by 2pm.  Quiet a big cut under my arm but just sore not painful.  I am keeping my arm mobile and stretching slowly up and rotating my shoulder to excercise it. 

The oncologist said I will not need chemo as there is no benefit to this when they put my details into a chart but I would have radiotherapy when the wound was healed. 

There seems to be some differences around as to having chemo first then clearance then radiotherapy. Or clearance, chemo, radiotherapy. 

I am unbelievably tired and I read that radiotherapy makes you tired as well. I have MS as well and I know that this is not helping me so I potter about so I don’t stay all day in bed or the sofa.  


Hello. I am nearly 3weeks on from having the LN clearance. Have had my Sedona drained twice and go Monday am to have it done again. At the moment the swelling has eased and I have no swelling on my arm. Just very tender on the side of my arm.
I use palmers cocoa butter religiously. I have healed amazingly quickly they tell me. And I move my arm around constantly even through pain as this helps so much. So physically I am doing well. But emotionally I am crap. My problem is I have MS. and know how to give the impression of always being strong, but just for one moment today I can’t. Cancer sucks! Tomorrow is another day and I will be better? Take good care of yourselves x

I’m in the same situation as you not sure which way to go good luck x

Hello Sarah
I had similar to you . WLE and sentinel node biopsy - found one node cancer and the other clear
They offered me posnoc trial which I declined as didn’t want computer deciding my fate / treatment etc and was also offered aux radiotherapy which also declined becos of the risks assoc with it combined with radiotherapy treatment to the breast .
So left me having to go for the axillary node clearance which I understand will be all nodes all levels . I’m not looking forward to surgery nor pain assoc with it
Let us know how you get on with the op

I am still recovering from SNB where I contracted a haematona 10 days after surgery . Swelling has reduced however I’m still very sore :frowning:

Hi, had breast surgery recently to remove a tumour and had one lymph node removed which showed  up cancerous to,surgery went fine and healed well ,but I was offered the posnoc Trial leaflets to read over before my oncologist appointment,I just don’t know what to do, I fear cancer this might pop up anytime in my life anywhere, And just want it to go away so feel chemo is my only option is anyone else in this dilemma…