Personalizing Locoregional Therapy in Patients With Breast Cancer in 2024: Tailoring Axillary Surgery, Escalating...

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Axillary lymph node management in breast cancer is shifting towards less invasive approaches.
• Axillary lymph node dissection (ALND) is associated with lymphedema, prompting de-escalation strategies.
• Radiotherapy has been optimized for reduced treatment burden and improved outcomes.

Purpose of the Study:

• To review the latest advancements in axillary surgical staging for breast cancer.
• To discuss updates in lymphatic surgery for managing lymphedema.
• To outline evidence-based radiotherapy techniques and future directions.

Main Methods:

• Review of recent clinical data supporting omission of ALND in select breast cancer patients.
• Analysis of current guidelines for sentinel lymph node biopsy (SLNB) omission.
• Summary of advancements in radiotherapy, including hypofractionation and simultaneous integrated boost (SIB).

Main Results:

• ALND can be omitted in most patients with limited SLN metastases or isolated tumor cells post-neoadjuvant chemotherapy.
• SLNB omission is considered for postmenopausal women with small, node-negative luminal breast cancer.
• Hypofractionated radiotherapy and SIB significantly reduce treatment duration and side effects.

Conclusions:

• De-escalation of axillary staging is supported by current evidence, reducing lymphedema risk.
• Optimized radiotherapy regimens offer shorter treatment courses with comparable efficacy.
• Ongoing trials aim to further refine de-escalation strategies in breast cancer management.