A Radiation Oncologist’s Guide to Axillary Management in Breast Cancer: a Walk Through the Trials

  • Julie K. Jang
  • Elana R. Sverdlik
  • Naomi R. SchechterEmail author
Clinical Trials (JE Lang, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Clinical 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.

Recent Findings

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.


Axilla 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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Julie K. Jang
    • 1
  • Elana R. Sverdlik
    • 2
  • Naomi R. Schechter
    • 1
    Email author
  1. 1.Department of Radiation OncologyUSC Norris Comprehensive Cancer Center, Keck School of Medicine of USCLos AngelesUSA
  2. 2.Department of Surgical OncologyUSC Norris Comprehensive Cancer Center, Keck School of Medicine of USCLos AngelesUSA

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