title: Management of the regional lymph nodes following breast-conservation therapy for early-stage breast cancer: an evolving paradigm.
abstract: Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit.
authors.affiliation: Harvard Radiation Oncology Program, Boston, Massachusetts.
authors.forename: Laura E G
authors.initials: LE
authors.lastname: Warren
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Rinaa S
authors.initials: RS
authors.lastname: Punglia
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Wong
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: jbellon@lroc.harvard.edu.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Bellon
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D015182:Lymphatic Irradiation / Q000009:adverse effects / Q000379:methods; D015412:Mastectomy, Segmental; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D021701:Sentinel Lymph Node Biopsy