Peritumoral lidocaine before breast cancer surgery (Tata Memorial)
Injecting a common local anaesthetic around the tumour minutes before surgery cut the risk of recurrence and death in a 1,583-woman Indian trial, at almost no cost.
Overview
1,583 women with early breast cancer were randomised to peritumoral lidocaine (n=796) or no injection (n=804) before surgery. At 5 years disease-free survival was 86.6% versus 82.6% (hazard ratio 0.74; P=0.017), overall survival 90.1% versus 86.4% (hazard ratio 0.71; P=0.019) and distant recurrence 8.5% versus 11.6% (hazard ratio 0.73), with no adverse events from the intervention. The proposed mechanism is blockade of voltage-gated sodium channels and surgery-induced tumour cell activation and dissemination. Confirmation in other populations is awaited before guideline adoption, but the trial is a model of the cheap, mechanism-led perioperative interventions Tata Memorial has pursued for two decades.
- 86.6 vs 82.6 out of 100 alive without the cancer coming back at 5 years with Peritumoral lidocaine compared with No lidocaine; 4 more per 100.
- Roughly one extra person helped for every 25 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- Put another way, the treated group had about 26 percent lower chance of the event at any given time (hazard ratio 0.74).
- The p-value (0.017) says a difference this large would rarely happen by chance; it does not say how large or how useful the difference is.
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- 90.1 vs 86.4 out of 100 alive at 5 years with Peritumoral lidocaine compared with No lidocaine; 3.7 more per 100.
- Roughly one extra person helped for every 27 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- Put another way, the treated group had about 29 percent lower chance of the event at any given time (hazard ratio 0.71).
- The p-value (0.019) says a difference this large would rarely happen by chance; it does not say how large or how useful the difference is.
- Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
- These results apply to the people the trial enrolled: Early breast cancer: peritumoral infiltration of 0.5% lidocaine immediately before surgery vs surgery alone. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
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