title: Relationship of clinical and pathologic nodal staging in locally advanced breast cancer: current controversies in daily practice?
abstract: Systemic neo-adjuvant therapy plays a primary role in the management of locally advanced breast cancer. Without having any negative effect in overall survival, induction chemotherapy potentially assures a surgery approach in unresectable disease or a conservative treatment in technically resectable disease and acts on a well-vascularized tumor bed, without the modifications induced by surgery. A specific issue has a central function in the neo-adjuvant setting: lymph nodes status. It still represents one of the strongest predictors of long-term prognosis in breast cancer. The discussion of regional radiation therapy should be a matter of debate, especially in a pathological complete response. Currently, the indication for radiotherapy is based on the clinical stage before the surgery, even for the irradiation of the loco-regional lymph nodes. Regardless of pathological down-staging, radiation therapy is accepted as standard adjuvant treatment in locally advanced breast cancer.
authors.affiliation: Cattedra di Radioterapia, Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-Patologiche, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: De Felice
authors.affiliation: Cattedra di Radioterapia, Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-Patologiche, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Musio
authors.affiliation: Cattedra di Radioterapia, Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-Patologiche, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Bulzonetti
authors.affiliation: Cattedra di Radioterapia, Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-Patologiche, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Raffetto
authors.affiliation: Cattedra di Radioterapia, Dipartimento di Scienze Radiologiche Oncologiche e Anatomo-Patologiche, "Sapienza" University of Rome, Rome, Italy ; Fondazione Spencer-Lorillard, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tombolini
keywords: Breast cancer; Clinical stage; Lymph nodes; Pathologic; Staging