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Radiotherapy or axillary lymph node dissection in breast cancer patients with positive sentinel lymph nodes?
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Abstract
Over the years the surgical management of localized breast cancer has become less aggressive. Complete resection of the primary tumour with negative margins replaced mastectomy and is currently a standard of care in a vast majority of women with early breast cancer. Also, an introduction of sentinel lymph node biopsy allowed for giving up axillary lymph node dissection in the patients with pathologically negative sentinel nodes. This development has led to a decrease of morbidity such as lymphedema. However, the standard management of axilla in the patients with positive sentinel lymph nodes remains controversial. Recent studies demonstrated that in the patients with 1 or 2 positive sentinel lymph nodes who undergo breast conserving surgery followed by conventionally fractionated whole-breast radiotherapy, a completion axillary lymph node dissection can be avoided. Furthermore, evidence from three two-phase non-inferiority studies comparing radiotherapy with complete lymph node dissection did not show any significant differences in either overall and disease-free survival, or local control and decrease of the percentage of patients with local adverse effects in radiotherapy arms. However, there are several methodological drawbacks and clinical limitations of these studies, which prevent from general omission of completion axillary lymph node dissection in breast cancer patients with positive sentinel lymph nodes. The debate held during V Annual Conference of Nowotwory Journal of Oncology and resulting article discusses the optimal management of axilla in this population.
Abstract
Over the years the surgical management of localized breast cancer has become less aggressive. Complete resection of the primary tumour with negative margins replaced mastectomy and is currently a standard of care in a vast majority of women with early breast cancer. Also, an introduction of sentinel lymph node biopsy allowed for giving up axillary lymph node dissection in the patients with pathologically negative sentinel nodes. This development has led to a decrease of morbidity such as lymphedema. However, the standard management of axilla in the patients with positive sentinel lymph nodes remains controversial. Recent studies demonstrated that in the patients with 1 or 2 positive sentinel lymph nodes who undergo breast conserving surgery followed by conventionally fractionated whole-breast radiotherapy, a completion axillary lymph node dissection can be avoided. Furthermore, evidence from three two-phase non-inferiority studies comparing radiotherapy with complete lymph node dissection did not show any significant differences in either overall and disease-free survival, or local control and decrease of the percentage of patients with local adverse effects in radiotherapy arms. However, there are several methodological drawbacks and clinical limitations of these studies, which prevent from general omission of completion axillary lymph node dissection in breast cancer patients with positive sentinel lymph nodes. The debate held during V Annual Conference of Nowotwory Journal of Oncology and resulting article discusses the optimal management of axilla in this population.
Keywords
breast cancer, axillary lymph node dissection, radiotherapy, sentinel lymph node
Title
Radiotherapy or axillary lymph node dissection in breast cancer patients with positive sentinel lymph nodes?
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Other materials agreed with the Editors
Pages
38-41
Published online
2018-06-20
Page views
949
Article views/downloads
932
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2018;68(1):38-41.
Keywords
breast cancer
axillary lymph node dissection
radiotherapy
sentinel lymph node
Authors
Aleksandra Łacko
Wojciech M. Wysocki