title: How do I deal with the axilla in patients with a positive sentinel lymph node?
abstract: Optimal management of the axilla in a patient with a positive sentinel node biopsy is not yet defined.These patients usually have Breast Conserving Surgery and receive adjuvant systemic therapy and whole breast radiation.Treatment options for the axilla include:                                                            no further surgery with or without radiation                                                                                       completion axillary nodal dissection with or without radiation                                                                           Radiation options in addition to whole breast radiation include                                                            axillary and supraclavicular nodal irradiation                                                                                       regional nodal irradiationincludes supraclavicular and internal mammary nodes                                                                           Completion axillary dissection has been standard practice in patients with positive sentinel nodes.                                                           the number of involved nodes provides prognostic information.                                                                                       theoretically improves local control, but may be obviated by systemic chemotherapy.                                                                           but                                                           avoidance of dissection may not adversely affect locoregional control or survival.                                                                                       dissection has significant morbidity so safe avoidance is desirable.                                                                           There is little worldwide concordance on the use of radiation:                                                           whole breast radiation (commonly used after breast conserving surgery) may  radiate the lower axilla                                                                                       supraclavicular radiation is most commonly recommended for patients with four or more nodes but may confer a survival benefit on patients with lower risk disease.                                                                                       adding nodal irradiation reduces local recurrence with only modest toxicity.                                                                           Adjuvant systemic therapy provides a survival benefit for patients with nodal disease. Most will receive cytostatic chemotherapy containing an anthracycline and a taxane. Hormone therapy is appropriate for estrogen receptor positive disease. The extent to which systemic therapy controls microscopic nodal disease is unknown. Node positive patients should generally receive adjuvant chemotherapy.A small group of patients benefit from specific nodal therapy. Further studies are needed to better identify these patients.
authors: Department of Oncology, Queen's University and CCSEO at Kingston General Hospital, Ontario, Canada. conrad.falkson@krcc.on.ca
authors: Conrad B
authors: CB
authors: Falkson
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome