Radiotherapy of the Lymphatic Pathways in Early Breast Cancer

Abstract

International guidelines reveal substantial differences regarding indications for regional nodal irradiation (RNI). Recently, several randomized studies provided new insights and these are discussed here. Patients with 1-3 positive nodes seem to profit from RNI compared to whole-breast (WBI) or chest-wall irradiation (CWI) alone, both with regard to locoregional control and disease-free survival. Irradiation of the regional lymphatics including axillary, supraclavicular and internal mammary nodes provided a small but significant survival benefit in recent randomized trials and 1 meta-analysis. Lymph node irradiation yields comparable tumor control in comparison to axillary lymph node dissection while reducing the rate of lymph edema. Data concerning the impact of 1-2 macroscopically affected sentinel nodes or microscopic metastases on prognosis are equivocal. Recent data suggest that the current restrictive use of RNI should be scrutinized, as the hazard-benefit relation appears to shift towards an improvement of outcome.

Current controversies in radiotherapy for breast cancer

“…Several trials on RNI in early stage breast cancer were recently published [32]. Design and results of those trials are summarized in Table 2.…”

Evaluation of the Brachial Plexus With Shear Wave Elastography After Radiotherapy for Breast Cancer

“…Radiation therapy (RT) has been established as one of the important advances in the treatment of breast cancer after mastectomy or breast‐conserving surgery . Patients receiving RT for breast cancer in acute or chronic courses may have a range of upper limb problems, such as loss of sensation, muscle weakness, and pain in relation to brachial plexus injury .…”