Regional Nodal Recurrence in the Management of Breast Cancer Patients with One to Three Positive Axillary Lymph Nodes

Abstract

Regional recurrence is uncommon among patients with one to three positive axillary lymph nodes treated with surgery, adequate axillary dissection, and tangential field irradiation only. The authors conclude that regional nodal irradiation should not routinely be given following adequate axillary dissection when only one to three lymph nodes are positive.

Neutron Versus Photon Radiotherapy for Local Control in Inoperable Breast Cancer

“…Radiotherapy, an important palliative modality in these cases, protects against ulceration, hemorrhage and brachial plexopathy [15,28,35]. In countries with limited resources, such as South Africa, breast cancer is often diagnosed late [9,21]; so the treatment of inoperable, advanced local disease is of particular relevance.…”

The Use of Molecular Imaging to Evaluate Radiation Fields in the Adjuvant Setting of Breast Cancer

“…Where discussion still exists on the place of postoperative regional irradiation when one to three lymph nodes are involved, in case of a higher number of involved nodes and a high incidence of extracapsular spread it reduces regional failure and might improve survival [5,8,14,18,22,23]. In this small series, we tried to assess the usefulness of preoperative FDG-PET, showing nodal involvement, in optimizing the treatment to the axillary and supraclavicular region.…”

Austrian Breast Cancer Patterns-of-Care Studies PCS93 and PCS01 versus PCS85 to Identify Changes in National Practice

“…In patients surveyed by the Austrian Breast Cancer Patterns-of-Care Studies, the percentage of patients treated with supraclavicular node irradiation diminished clearly from 77% (PCS85) to 35% (PCS93) and 28% (PCS01). At present, several indications for supraclavicular node radiotherapy are under discussion such as patients with ≥ 4 positive axillary nodes irrespective of T-category or patients with ≥ pT2 tumors and 1-3 positive axillary nodes or extracapsular tumor extension [4,8,9,33,34]. In PCS01, 34 of 120 patients received supraclavicular radiotherapy and 85% of them fulfilled these criteria.…”

“…The broad spectrum of possible ways to deliver a boost is reflected in the Austrian Patterns-of-Care Studies including low-dose-rate brachytherapy (PCS85), HDR brachytherapy (PCS85, PCS93, and PCS01), external teletherapy (PCS85, PCS93, and PCS01), and intraoperative teletherapy (PCS01). While some centers in Austria have a history of operational experience with implants [6,11,21,26,29], others prefer teletherapy [34] or investigate intraoperative techniques [24,25,28]. Whenever discussing the proportion of "additional boost" treatment in a patient cohort, it is imperative that the total dose to the breast/ chest wall is taken into account.…”