A Radiation Oncologist ’s Guide to Axillary Management in Breast Cancer: a Walk Through the Trials

AbstractPurpose of ReviewThe axilla is the most common site for breast cancer nodal metastases. Aggressive management includes axillary lymph node dissection (ALND), radiotherapy, and systemic therapy, but carries the risks of lymphedema and “overtreatment”. We review the clinical trials that led to de-escalation of axillary management and their nuances that are often overlooked.Recent FindingsWith the rise of sentinel lymph node biopsy, several trials conclude that ALND can be omitted in specific populations. However, the subtleties in those trials, such as the role of chemotherapy and radiotherapy, have yet to be clarified. These discussions carry forward into the era of neoadjuvant chemotherapy, where ongoing trials investigate who needs ALND and/or radiation.SummaryThis review examines the clinical trials that form the standard of care, and highlights why axillary management is individualized today.
Source: Current Breast Cancer Reports - Category: Cancer & Oncology Source Type: research

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Conditions:   Autonomic Nervous System Imbalance;   Psychological Distress;   Cancer-related Pain;   Breast Cancer Lymphedema;   Quality of Life Interventions:   Device: Andullation;   Other: Placebo Sponsor:   Universitair Ziekenhuis Brussel Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Conditions:   Breast Cancer;   Lymphedema Interventions:   Procedure: 14 sessions of manual lymphatic drainage technique;   Other: the health education Sponsors:   University of Castilla-La Mancha;   Castilla-La Mancha Health Service Completed
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
This study did not include women who had mastectomies or suspicious or enlarged lymph nodes in a physical exam." To make sure that women have the appropriate lymph node surgery, the American Society for Clinical Oncology released guidelines on sentinel lymph node biopsy for people diagnosed with early-stage breast cancer. The guidelines say sentinel lymph node biopsy SHOULD be offered under these circumstances:breast cancer in which there is more than one tumor, all of which have formed separately from one another (doctors call these multicentric tumors); these types of breast cancers are rareDCIS treated with mastect...
Source: Caroline's Breast Cancer Blog - Category: Cancer & Oncology Tags: breast cancer breast cancer treatment young cancer patients Source Type: blogs
Background: Breast Cancer-Related Lymphedema (BCRL) is a chronic, iatrogenic condition that can occur after damage to the lymphatic system during surgery (sx) or radiation, precipitating edema of the arm, breast, or trunk. BCRL risk-reduction education is an essential component of clinical care, and practitioners often advise patients (pts) to avoid needle punctures on the treated arm when possible. There is, however, a lack of substantial scientific evidence to lessen patient distress. Considering the common use of chemotherapy (CT) agents in this population, we assessed whether repeated skin punctures on the ipsilateral ...
Source: Cancer Research - Category: Cancer & Oncology Authors: Tags: Poster Discussion Abstracts Source Type: research
This study evaluates patient-reported arm symptoms in women treated with HF compared to conventional fractionation (CF) RT (defined as ≤2Gy/fraction).Materials / Methods: Provincial cancer registries were used to identify subjects who received 3D, CT-planned nodal RT for pT1-3 pN0-2 M0 breast cancer from 2007-2009 in British Columbia and 2008 – 2010 in Alberta, Canada. Treatment eras were selected to enable sufficient follow-up time to develop late arm symptoms. Following research ethics approval, eligible patients were mailed an explanation letter and an externally validated, Self-reported Arm Symptom Scale (SASS...
Source: Cancer Research - Category: Cancer & Oncology Authors: Tags: Poster Session Abstracts Source Type: research
This study is conducted to investigate the incidence and time course of LE after NCT. Materials and Methods A total of 313 patients with clinically node-positive breast cancer who underwent NCT followed by surgery with axillary lymph node (ALN) dissection from 2004 to 2009 were retrospectively analyzed. All patients received breast and supraclavicular radiation therapy (SCRT). The determination of LE was based on both objective and subjective methods, as part of a prospective database. Results At a median follow-up of 5.6 years, 132 patients had developed LE: 88 (28%) were grade 1; 42 (13%) were grade 2; and two (1%) were ...
Source: Cancer Research and Treatment - Category: Cancer & Oncology Tags: Original Article Source Type: research
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