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Regional Nodal Radiation as an Alternative to Surgery

  • Krystyna Kiel
Chapter

Abstract

The axillary nodes are often the first site of detected metastases of breast cancer. Unfortunately, clinical examination is inaccurate in determining axillary metastases. The false negative rate is reported at 25–31% in a clinical negative axilla with a similar false positive rate at 27–33% when axillary nodes are palpable. Radiological (ultrasound) or nuclear medicine (PET) testing is somewhat better, but only if the lymph node is enlarged or distorted by metastases. Untreated microscopic involvement of lymph nodes has the potential of future systemic “seeding” and local progression resulting in symptoms, such as lymphedema and brachial plexus involvement. Axillary radiotherapy can be used to treat the axilla in high risk patients or in those who refuse axillary surgery. Axillary radiotherapy is also being evaluated as a possible substitute for a completion lymph node dissection in those with an involved sentinel node. As with any cancer therapy, axillary radiotherapy has potential morbidity. This chapter reviews the potentially utility of axillary radiotherapy.

Keywords

Sentinel Node Sentinel Node Biopsy Axillary Node Axillary Dissection Positive Sentinel Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Wallace IW, Champion HR. Axillary nodes in breast cancer. Lancet. 1972;1:692.PubMedCrossRefGoogle Scholar
  2. 2.
    Fisher B, Wolmark N, Bauer M, et al. The accuracy of clinical nodal staging and of limited axillary dissection as a determinant of histological nodal status in carcinoma of the breast. Surg Gynecol Obstet. 1981;152:765.PubMedGoogle Scholar
  3. 3.
    Veronesi U, DeCicco C, Galimbert VE, et al. A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol. 2007;18:473–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Sahoo S, Sanders MA, Roland L, et al. A strategic approach to the evaluation of axillary lymph nodes in breast cancer patients: Analysis of 168 patients at a single institution. Am J Surg. 2007;194:524.PubMedCrossRefGoogle Scholar
  5. 5.
    Withers HR, Lee SP. Modeling growth kinestics and statistical distribution of oligometastases. Semin Radiat Oncol. 2006;16:20101–9.CrossRefGoogle Scholar
  6. 6.
    NCCN Clinical Practice Guidelines in Oncology, Breast Cancer V.2.2101,2008. @National Comprehensive Cancer E=Network, Inc. Available at http://www.nccn.org. Accessed 04 Sep 10
  7. 7.
    Overgaard M, Nielsen HM, Overgaard J. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 B&C randomized trials. Radiother Oncol. 2007;82:247–54.PubMedCrossRefGoogle Scholar
  8. 8.
    Sylvestre CL, Krishna C, Asselan B, Bicoq JR, Salmon RJ, Campan F, et al. Axillary treatment in conservative management of operable breast cancer: dissection or radiotherapy? Results of a randomized study with 15 years of follow-up. J Clin Oncol. 2004;22:97–101.CrossRefGoogle Scholar
  9. 9.
    Veronesi U, Orecchia R, Zurrida S, et al. Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy. Ann Oncol. 2005;16:383–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Kim T, Guiliano A, Lyman GH, et al. Lymphatic mapping and sentinel lymph node sampling in early-stage breast cancer. A Meta-analysis. Cancer. 2006;106:4–16.PubMedCrossRefGoogle Scholar
  11. 2010.
    Carcofora P, Maestroni U, Querzoli P, et al. Primary breast cancer features can predict ­additional lymph node involvement in patients with sentinel node micrometastases. World J Surg. 2006;30:1653–7.CrossRefGoogle Scholar
  12. 12.
    Nos C, Harding-MacKean C, Freneauz P, et al. Prediction of tumour involvement in remaining axillary lymph nodes when the sentinel node in a woman with breast cancer contains metastases. Br J Surg. 2003;90:1354–60.PubMedCrossRefGoogle Scholar
  13. 13.
    Weiser MR, Montgomery LL, Tan LK, et al. Lymphovascular invasion enhances the prediction of non-sentinel node metastases in breast cancer patients with positive sentinel nodes. Ann Surg Oncol. 2001;8:145–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Ponzone R, Maggiorotto F, Mariani L, et al. Comparison of two models for the prediction of nonsentinel node metastases in breast cancer. Am J Surg. 2007;2007:688–92.Google Scholar
  15. 15.
    Galper S, Recht A, Silver B, et al. Is radiation alone adequate treatment to the axilla for patients with limited axillary surgery? Implications for treatment after a positive sentinel node biopsy. Int J Radiat Biol Phys. 2002;48:124–32.Google Scholar
  16. 16.
    Galper Sarvi M, Mehta P, Vallow L, et al. Is nodal irradiation necessary in breast cancer patients with positive sentinel node biopsy without axillary dissection. Int J Radiat Biol Phys. 2002;54 Suppl 2:232–3.Google Scholar
  17. 17.
    Guenther JM, Hansen NM, DiFronzo LA, et al. Axillary dissection is not required for all patients with breast cancer and positive sentinel nodes. Arch Surg. 2003;138:52–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Fant JS, Grant MD, Knox SM, et al. Preliminary outcome analysis in patients with breast cancer and a positive sentinel lymph node who declined axillary dissection. Ann Surg Oncol. 2003;10:126–30.PubMedCrossRefGoogle Scholar
  19. 19.
    Katz A, Smith BL, Golshan M, et al. Factors associated with involvement of four or more axillary nodes for sentinel lymph node positive patients. Int J Radiat Biol Phys. 2006;66 Suppl 3:S6–7.Google Scholar
  20. 20.
    Naik AM, Fey J, Gemignani M, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg. 2004;240:462–71.PubMedCrossRefGoogle Scholar
  21. 21.
    Rutgers EJ, Meignen P, Bonnefoi H. Clinical trials update of the European Organization for Research and Treatment of Cancer Breast Cancer Group. Breast Cancer Res. 2004;5:154–69.Google Scholar
  22. 22.
    Chung MA, DiPetrillo T, Hernandez S, et al. Treatment of the axilla by tangential breast radiotherapy in women with invasive breast cancer. Am J Surg. 2002;184:401–2.PubMedCrossRefGoogle Scholar
  23. 23.
    Kiel KD, Chang S, Small W, et al. Is it possible to treat the axillary nodes in the same radiation fields covering the breast? A study to locate the limits of the axillary dissection ­relative to anatomic landmarks in the tangential fields? Int J Radiat Oncol Biol Phys. 2997;39 Suppl 2:265.Google Scholar
  24. 24.
    Schlembach PJ, Buchholz TA, Ross MI, et al. Relationship of sentinel and axillary level I-II lymph nodes to tangential fields used in breast irradiation. Int J Radiat Biol Phys. 2001;51:671–8.CrossRefGoogle Scholar
  25. 25.
    Greco M, Agresti R, Cascinelli N, et al. Breast cancer patients treated without axillary surgery. Ann Surg. 2000;232:1–7.PubMedCrossRefGoogle Scholar
  26. 26.
    International Breast Cancer Study Group. Axillary clearance in older patients with breast cancer: first results of international breast cancer study group trial 10–93. J Clin Oncol. 2006;24:337–44.Google Scholar
  27. 27.
    Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without ­irradiation in women 70 years of age or older with early breast cancer: a report of further follow-up. Breast Cancer Symposium. San Antonio; 2006, abstract 2010.Google Scholar
  28. 28.
    Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J NCI. 2006;98:599–609.Google Scholar
  29. 29.
    Fisher B, Jeong J-H, Anderson S, et al. Twenty-five year follow-up of a randomized tiral ­comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347:567–75.PubMedCrossRefGoogle Scholar
  30. 30.
    Wazer DE, Erban JK, Robert NJ, et al. Breast conservation in elderly women for clinical negative axillary lymph nodes without axillary dissection. Cancer. 1994;74:878–83.PubMedCrossRefGoogle Scholar
  31. 31.
    Halverson KJ, Taylor ME, Perez CA et al. Int J Radiat Oncol Bio Phys. 1993;26:593–9.Google Scholar
  32. 32.
    Chua B, Ung O, Boyages J. Treatment of the axilla in early breast cancer: past, present and future. ANZ J Surg. 2001;71:729–36.PubMedCrossRefGoogle Scholar
  33. 33.
    Renolleau C, Merviel P, Clough KB, et al. Isolated axillary recurrences after conservative treatment of breast cancer. Eur J Cancer. 1996;32A:617–21.PubMedCrossRefGoogle Scholar
  34. 34.
    Bilimoria KY, Bentrem DJ, Hasen NM, Bethke KP, Rademaker AW, Ko CY, Winchester DP, Winchester DJ. Journal Clinical Oncology. 2009;27:2946–2953.PubMedCrossRefGoogle Scholar
  35. 35.
    Fernando SA, Edge SB. Evidence and controversies in the use of post-mastectomy radiation. Journal of the National Comprehensive Cancer Network. 2007;5(3):331–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer New York 2010

Authors and Affiliations

  1. 1.Savannah Radiation Cancer CareSavannahUSA

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