Axillary radiotherapy: an alternative treatment option for adjuvant axillary management of breast cancer

Abstract

Axillary lymph node dissection is standard management of axilla in invasive breast cancer. Radiotherapy also is important in local treatment. It is controversial as to whether axillary radiotherapy can displace axillary lymph node dissection. We performed a meta-analysis comparing axillary radiotherapy with axillary dissection. No significant difference was observed for disease free survival and overall survival between the radiation group and the dissection group. There was also no significant difference in either the axillary recurrence or the local recurrence between the two groups. But the axillary relapse rate in the radiation group was higher than in the surgery group at five-year follow-up while the local recurrence rate in the surgery group was higher than in the radiation group. A subgroup analysis showed that the difference in the axillary recurrence rate (RR = 0.20, P = 0.01) and local recurrence rate (RR = 4.7, P = 0.01) mainly appeared in the clinical node-positive subgroup. The edema rate in the surgery group was higher than in the radiation group (RR = 2.08, 95%: 1.71–2.54, P < 0.0001). We concluded that radiotherapy may be an alternative treatment option for adjuvant management of the axilla in selected sub-groups of patients.

Axillary lymph node dissection vs sentinel biopsy only among women with early‐stage breast cancer and sentinel node metastasis: A systematic review and meta‐analysis

“…Only a few meta‐analyses 11‐15 have been previously performed to compare the difference in OS, DFS, and recurrence rates between SLND/RT and ALND in early breast cancer patients with limited sentinel node metastasis. Nonetheless, these meta‐analyses did not come to robust conclusions whether SLND results in improved effectiveness compared to ALND.…”

Practical consensus recommendations regarding role of postmastectomy radiation therapy

“…A meta-analysis performed to compare axillary radiotherapy and axillary dissection showed no significant difference in disease free survival and overall survival between the radiation group and the dissection group. [25] There was also no significant difference in either the axillary recurrence or the local recurrence between the two groups. A study by Recht et al [26] analyzed the likelihood of regional nodal failure (RNF) for 1,624 patients with stage I or II invasive breast carcinoma treated with conservative surgery and radiotherapy (RT).…”

Association of Axillary Lymph Node Evaluation With Survival in Women Aged 70 Years or Older With Breast Cancer

“…We were concerned that the survival of SLNB group patients is concentrated in the stage N0 patients; in the stage N1 and above patients ALND still needs to be selected. A meta-analysis based on four trials showed no significant differences in OS and DFS between ALND and regional nodal irradiation (RNI) in short- or long-term outcomes ( 24 ). Hence, RNI may be an alternative treatment for adjuvant management of the axilla in selected patients, and an optimal radiation strategy approach for elderly patients warrants further study.…”