Conservative treatment of early breast cancer

Primary axillary radiotherapy as axillary treatment in breast-conserving therapy for patients with breast carcinoma and clinically negative axillary lymph nodes

“…Side effects that have been observed include arm edema (2-8%), impaired shoulder mobility (0 -9%), brachial plexus neuropathy (1-2%), axillary fibrosis (10%), and radiation-induced pneumonitis (1-9%). [11][12][13][14][15][16][17][18][19][20][21][22][23] Our findings are in agreement with the literature. Remarkable discrepancy was observed between subjectively and objectively reported complications.…”

“…This resulted in an overall axillary recurrence rate of 2%, which is comparable to the data reported in other retrospective series, applying ART. [11][12][13][14][15][16][17][18][19][20][21][22][23] The axillary recurrence rates in these series with mainly megavoltage techniques and uniform dose levels (45-50 Gy in 5 weeks) vary between 0.6 and 3.6% with one exception reporting a recurrence rate of 16%. 13 The reported axillary recurrence rate in our series is comparable to the recurrence rate (2%) after BCT, including ALND without ART, in a large series treated in our institute.…”

“…Furthermore, given the established value of adjuvant systemic therapy for most patients regardless of lymph node status, 10 the value of ALND in deciding the use of adjuvant therapy is now limited. Alternative axillary treatment strategies for early stage breast carcinoma include axillary radiotherapy (ART), [11][12][13][14][15][16][17][18][19][20][21][22][23] no axillary therapy in case of very favorable prognostic criteria, 24 and sentinel lymph node biopsy. 25,26 The purpose of the current study was to evaluate the outcome of treatment of postmenopausal women with early stage clinically lymph node negative invasive breast carcinoma, who were treated by ART instead of ALND as part of breast-conserving therapy (BCT).…”

Primary Tumor Response to Induction Chemotherapy as a Predictor of Histological Status of Axillary Nodes in Operable Breast Cancer Patients

“…9,18,19,34 In addition, overall survival times in clinically node-negative breast cancer patients treated with either AXRT or ALND have been found to be comparable, although additional prospective trials are needed to substantiate these findings. 9,35,36 …”

“…10,16,17 AXRT has been demonstrated to be as effective as ALND for local control in clinically node-negative patients with a significant risk of nodal metastases, with a percentage of axillary failure of only about 1%. 10,18,19 At the M. D. Anderson Cancer Center, we have increasingly used induction chemotherapy (IC) for treatment of patients who would be candidates for systemic chemotherapy by primary tumor characteristics. 20,21 In a significant number of patients, even those with locally advanced cancers, tumor downsizing is sufficient to make them appropriate candidates for breast-conserving surgery.…”