A Radiation Oncologist’s Guide to Axillary Management in Breast Cancer: a Walk Through the Trials
Purpose of Review
The axilla is the most common site for breast cancer nodal metastases. Aggressive management includes axillary lymph node dissection (ALND), radiotherapy, and systemic therapy, but carries the risks of lymphedema and “overtreatment”. We review the clinical trials that led to de-escalation of axillary management and their nuances that are often overlooked.
With the rise of sentinel lymph node biopsy, several trials conclude that ALND can be omitted in specific populations. However, the subtleties in those trials, such as the role of chemotherapy and radiotherapy, have yet to be clarified. These discussions carry forward into the era of neoadjuvant chemotherapy, where ongoing trials investigate who needs ALND and/or radiation.
This review examines the clinical trials that form the standard of care, and highlights why axillary management is individualized today.
KeywordsAxilla Radiotherapy Breast cancer Axillary lymph node dissection Sentinel lymph node biopsy Lymph node metastasis
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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