title: The changing role of axillary treatment in breast cancer: Who will remain at risk for developing arm morbidity in the future?
abstract: Primary aim is to give an overview of changes in axillary staging and treatment of breast cancer patients. Secondly, we aim to identify patients with a high arm/shoulder morbidity risk, and describe a strategy to improve early detection and treatment. Recent and initiated studies on axillary staging and treatment were evaluated and clustered for clinically node negative and clinically node positive breast cancer patients, together with studies on pathology, detection and (surgical) prevention and treatment of lymphedema. For clinically node negative patients, the indication for axillary lymph node dissection in sentinel node positive patients is fading. On the contrary, clinically node positive patients are routinely subjected to an axillary lymph node dissection, in combination with other therapies associated with an increased lymphedema risk, such as mastectomy, adjuvant radiation- and (taxane-based) chemotherapy. Techniques for prevention, early detection and (surgical) treatment of lymphedema are being developed. Axillary staging and treatment in breast cancer patients with a clinically node negative status will become less invasive, thereby reducing the incidence of morbidity. Nevertheless, in patients with a clinically node positive status, aggressive treatment will still be required for oncologic control. For these patients, a surveillance program should be implemented in order to apply (curative) surgical treatment for lymphedema.
authors.affiliation: Department of Surgical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Plastic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: T R
authors.initials: TR
authors.lastname: Lopez Penha
authors.affiliation: Department of Surgical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW - School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: lorivanroozendaal@gmail.com.
authors.forename: L M
authors.initials: LM
authors.lastname: van Roozendaal
authors.affiliation: Department of Surgical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW - School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Smidt
authors.affiliation: Department of Radiation Oncology, Maastricht University Medical Center (MAASTRO Clinic), Maastricht, The Netherlands; GROW - School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: L J
authors.initials: LJ
authors.lastname: Boersma
authors.affiliation: Department of Surgical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: M F
authors.initials: MF
authors.lastname: von Meyenfeldt
authors.affiliation: Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.affiliation: Department of Surgical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: Heuts
mesh_terms: D001132:Arm; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D009367:Neoplasm Staging / Q000639:trends*; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012782:Shoulder
keywords: Axillary lymph node dissection; Breast neoplasms; Lymphedema; Morbidity; Radiation therapy; Sentinel lymph node biopsy