Treating Positive Nodes in the Axilla

  • سال انتشار: 1394
  • محل انتشار: یازدهمین کنگره بین المللی سرطان پستان
  • کد COI اختصاصی: ICBCMED11_011
  • زبان مقاله: انگلیسی
  • تعداد مشاهده: 372
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نویسندگان

C. Markopoulos

چکیده

By increasing breast cancer awareness and extending the use of breast cancer (BC) screening tools like mammography, we now diagnose BC in earlier stage. Accordingly, breast cancer surgery became less extensive and less mutilating. Axillary surgery has changed dramatically. Sentinel Lymph Node Biopsy (SLNB) became standard of care for clinically negative axilla and no further axillary surgery is necessary for patients found with micrometastasis in the SLN (pN1mi). Furthermore, although axillary lymph node dissection (ALND) remains the gold standard for patients with macrometastasis in the SLN (N1sn), two recent randomized trials have doubted the necessity for further surgery in patients with low burden disease. Z0011 trial (Guiliano et al Ann Surg Oncol 2012;19:4140-9) including patients with low burden node involvement, has shown a very low rate of local recurrence. The role of surgery in the positive axilla is further reduced as the EORTC AMAROS trial showed that patients with positive sentinel nodes may be effectively treated by radiotherapy to the axilla rather than radical axillary surgery (Donker et al Lancet Oncology 2014;15:1303- 1310); recurrence in the axilla after removal of a positive SLN was very low (< 1%) and not significantly different in the surgical versus radiotherapy groups, whilst the possibility of developing arm lymphedema was much lower in patients receiving radiotherapy instead of extensive surgery. However, inclusion criteria considering patients’ characteristics entered in these trials should be carefully taken into account when adopting the results and treatment policy of these trials in certain patients.

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