[Is axillary dissection in clinically lymph node-negative breast carcinoma further indicated?]

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Adjuvant systemic treatment for breast cancer now includes nodal-negative stages, reducing the importance of axillary dissection status.
• The necessity of axillary dissection in node-negative patients warrants reconsideration, exploring less morbid alternatives like axillary radiotherapy.

Purpose of the Study:

• To review international treatment experiences with axillary dissection, axillary radiotherapy, and sentinel node dissection (SLND).
• To report long-term experiences with conservative surgery and axillary radiotherapy in node-negative breast cancer patients.

Main Methods:

• Literature review of axillary dissection, axillary radiotherapy, and SLND treatment experiences.
• Analysis of 19 patients treated with conservative surgery and axillary radiotherapy without axillary dissection.

Main Results:

• Axillary radiotherapy shows a 2.0% median axillary recurrence rate and 2.7% regional recurrence rate.
• Axillary dissection has 1-2% axillary recurrence and 2.2% median regional recurrence rates; SLND precisely predicts nodal involvement.
• Meta-analysis indicates no significant difference in regional recurrence or survival between axillary dissection and radiotherapy.

Conclusions:

• Definitive axillary radiotherapy is a cost-effective, well-tolerated option for patients without palpable axillary nodes.
• Axillary radiotherapy can replace axillary dissection when systemic therapy is not dependent on axillary status.
• SLND is the preferred treatment for small tumors without risk factors and no indication for systemic therapy.