title: Radiotherapy of the Lymphatic Pathways in Early Breast Cancer.
abstract: International guidelines reveal substantial differences regarding indications for regional nodal irradiation (RNI). Recently, several randomized studies provided new insights and these are discussed here. Patients with 1-3 positive nodes seem to profit from RNI compared to whole-breast (WBI) or chest-wall irradiation (CWI) alone, both with regard to locoregional control and disease-free survival. Irradiation of the regional lymphatics including axillary, supraclavicular and internal mammary nodes provided a small but significant survival benefit in recent randomized trials and 1 meta-analysis. Lymph node irradiation yields comparable tumor control in comparison to axillary lymph node dissection while reducing the rate of lymph edema. Data concerning the impact of 1-2 macroscopically affected sentinel nodes or microscopic metastases on prognosis are equivocal. Recent data suggest that the current restrictive use of RNI should be scrutinized, as the hazard-benefit relation appears to shift towards an improvement of outcome.
authors.affiliation: Klinik für Radioonkologie und Strahlentherapie, Städtisches Klinikum Karlsruhe, Germany.
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Sautter-Bihl
authors.affiliation: Department of Radiotherapy and Radiation Oncology, LKH Salzburg, Paracelsus Medical University Hospital, Salzburg, Austria.
authors.forename: Felix
authors.initials: F
authors.lastname: Sedlmayer
keywords: Breast cancer; Radiotherapy; Regional nodal irradiation