A Paradigm Shift in Axillary Breast Cancer Treatment; From “Treat All-Except,” Toward “Treat None-Unless”

Comparison of Incidental Radiation Dose to Axilla and Internal Mammary Nodal Area by Conventional, 3DCRT, and IMRT Technique in Carcinoma of Breast

“…Trial conducted by American College of Surgeons Oncology Group (Z0011) randomized patients treated with breast conservation surgery and positive sentinel node biopsy (SNB) to standard axillary dissection or no further surgery, followed by radiation to breast alone in both the arms. The study concluded that at a median follow-up time of 6.3 years, there were no statistically significant differences in local recurrence (P=0.11) or regional recurrence (P=0.45) between the 2 groups [12]. One possibility is that dose less that 95% of prescription dose is adequate to treat clinically negative axilla/microscopic disease.…”

“…Many studies have shown there will be better long term axillary control with breast irradiation and higher nodal recurrence when breast irradiation is skipped [11,12]. That can have direct correlation, with standard tangents, the axilla receives a significant incidental dose but still adequate for clinical control of disease is unknown [18,19].…”

“…In a trial conducted by American College of Surgeons Oncology Group (Z0011), randomized patients of early breast cancer who underwent breast conservation surgery and had positive sentinel node biopsy (SNB) to standard axillary dissection or no further axillary surgery, followed by radiation to breast alone in both the arms. The study concluded that axillary failures were same in both the arms [12] raising the possibility that incidental dose of radiation to axilla when breast is being irradiated might contribute in eradicating microscopic disease in undissected axilla.…”