Skip to main content
Top
Published in: Current Breast Cancer Reports 2/2016

01-06-2016 | Local-Regional Evaluation and Therapy (EP Mamounas, Section Editor)

Regional Nodal Radiotherapy in Early-Stage Breast Cancer: Where Are We in 2016?

Authors: Robert T. Dess, Corey W. Speers, Lori J. Pierce

Published in: Current Breast Cancer Reports | Issue 2/2016

Login to get access

Abstract

The goal of locoregional treatment in early-stage breast cancer patients is to eradicate residual locoregional microscopic disease in order to maximize locoregional control, to minimize seeding of distant metastatic sites, and ultimately to improve overall survival. Recently published landmark randomized trials demonstrate that the addition of regional nodal radiotherapy to breast conserving therapy or mastectomy in node positive or high-risk node negative women not only improves locoregional control but also decreases distant metastasis with a trend towards improved overall survival with a favorable toxicity profile. Certain node-positive early-stage breast cancer patients, however, have low rates of axillary recurrence and high rates of breast cancer-specific survival even with sentinel lymph node excision alone without axillary lymph node dissection. Herein, we review the recent developments in regional nodal management and reconcile the apparent conflict between the surgical and radiotherapy literature. In this context, we provide guidance as to the patients appropriate for regional nodal radiotherapy in 2016 and highlight important treatment considerations to minimize long-term toxicity.
Literature
1.
go back to reference EBCTCG, McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127–35. doi:10.1016/S0140-6736(14)60488-8.CrossRef EBCTCG, McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127–35. doi:10.​1016/​S0140-6736(14)60488-8.CrossRef
2.
go back to reference Harris JR, Lippman ME, Osborne CK, Morrow M. Diseases of the breast. Philadelphia: Lippincott Williams & Wilkins; 2012. Harris JR, Lippman ME, Osborne CK, Morrow M. Diseases of the breast. Philadelphia: Lippincott Williams & Wilkins; 2012.
3.
go back to reference Voogd AC, Coebergh J-WW, van Driel OJR, Roumen RM, van Beek MW, Vreugdenhil A, et al. The risk of nodal metastases in breast cancer patients with clinically negative lymph nodes: a population-based analysis. Breast Cancer Res Treat. 2000;62(1):63–9.CrossRefPubMed Voogd AC, Coebergh J-WW, van Driel OJR, Roumen RM, van Beek MW, Vreugdenhil A, et al. The risk of nodal metastases in breast cancer patients with clinically negative lymph nodes: a population-based analysis. Breast Cancer Res Treat. 2000;62(1):63–9.CrossRefPubMed
4.
go back to reference Silverstein MJ, Skinner KA, Lomis TJ. Predicting axillary nodal positivity in 2282 patients with breast carcinoma. World J Surg. 2001;25(6):767–72.CrossRefPubMed Silverstein MJ, Skinner KA, Lomis TJ. Predicting axillary nodal positivity in 2282 patients with breast carcinoma. World J Surg. 2001;25(6):767–72.CrossRefPubMed
5.
go back to reference Fisher B, Jeong J-H, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347(8):567–75.CrossRefPubMed Fisher B, Jeong J-H, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347(8):567–75.CrossRefPubMed
6.
go back to reference Mustafa IA, Cole B, Wanebo HJ, Bland KI, Chang HR. Prognostic analysis of survival in small breast cancers. J Am Coll Surg. 1998;186(5):562–9.CrossRefPubMed Mustafa IA, Cole B, Wanebo HJ, Bland KI, Chang HR. Prognostic analysis of survival in small breast cancers. J Am Coll Surg. 1998;186(5):562–9.CrossRefPubMed
8.
go back to reference Chen RC, Lin NU, Golshan M, Harris JR, Bellon JR. Internal mammary nodes in breast cancer: diagnosis and implications for patient management—a systematic review. J Clin Oncol. 2008;26(30):4981–9.CrossRefPubMed Chen RC, Lin NU, Golshan M, Harris JR, Bellon JR. Internal mammary nodes in breast cancer: diagnosis and implications for patient management—a systematic review. J Clin Oncol. 2008;26(30):4981–9.CrossRefPubMed
9.
go back to reference Gaffney DK, Tsodikov A, Wiggins CL. Diminished survival in patients with inner versus outer quadrant breast cancers. J Clin Oncol. 2003;21(3):467–72.CrossRefPubMed Gaffney DK, Tsodikov A, Wiggins CL. Diminished survival in patients with inner versus outer quadrant breast cancers. J Clin Oncol. 2003;21(3):467–72.CrossRefPubMed
10.
go back to reference Kroman N, Wohlfahrt J, Mouridsen HT, Melbye M. Influence of tumor location on breast cancer prognosis. Int J Cancer. 2003;105(4):542–5.CrossRefPubMed Kroman N, Wohlfahrt J, Mouridsen HT, Melbye M. Influence of tumor location on breast cancer prognosis. Int J Cancer. 2003;105(4):542–5.CrossRefPubMed
11.
go back to reference Lohrisch C, Jackson J, Jones A, Mates D, Olivotto IA. Relationship between tumor location and relapse in 6,781 women with early invasive breast cancer. J Clin Oncol. 2000;18(15):2828–35.PubMed Lohrisch C, Jackson J, Jones A, Mates D, Olivotto IA. Relationship between tumor location and relapse in 6,781 women with early invasive breast cancer. J Clin Oncol. 2000;18(15):2828–35.PubMed
12.
go back to reference Sarp S, Fioretta G, Verkooijen HM, Vlastos G, Rapiti E, Schubert H, et al. Tumor location of the lower-inner quadrant is associated with an impaired survival for women with early-stage breast cancer. Ann Surg Oncol. 2007;14(3):1031–9.CrossRefPubMed Sarp S, Fioretta G, Verkooijen HM, Vlastos G, Rapiti E, Schubert H, et al. Tumor location of the lower-inner quadrant is associated with an impaired survival for women with early-stage breast cancer. Ann Surg Oncol. 2007;14(3):1031–9.CrossRefPubMed
13.
go back to reference Yu JI, Park W, Huh SJ, Choi DH, Lim YH, Ahn JS, et al. Determining which patients require irradiation of the supraclavicular nodal area after surgery for N1 breast cancer. Int J Radiat Oncol Biol Phys. 2010;78(4):1135–41.CrossRefPubMed Yu JI, Park W, Huh SJ, Choi DH, Lim YH, Ahn JS, et al. Determining which patients require irradiation of the supraclavicular nodal area after surgery for N1 breast cancer. Int J Radiat Oncol Biol Phys. 2010;78(4):1135–41.CrossRefPubMed
14.
go back to reference Livi L, Scotti V, Saieva C, Meattini I, Detti B, Simontacchi G, et al. Outcome after conservative surgery and breast irradiation in 5,717 patients with breast cancer: implications for supraclavicular nodal irradiation. Int J Radiat Oncol Biol Phys. 2010;76(4):978–83.CrossRefPubMed Livi L, Scotti V, Saieva C, Meattini I, Detti B, Simontacchi G, et al. Outcome after conservative surgery and breast irradiation in 5,717 patients with breast cancer: implications for supraclavicular nodal irradiation. Int J Radiat Oncol Biol Phys. 2010;76(4):978–83.CrossRefPubMed
15.
go back to reference Reed VK, Cavalcanti JL, Strom EA, Perkins GH, Oh JL, Tereffe W, et al. Risk of subclinical micrometastatic disease in the supraclavicular nodal bed according to the anatomic distribution in patients with advanced breast cancer. Int J Radiat Oncol Biol Phys. 2008;71(2):435–40.CrossRefPubMedPubMedCentral Reed VK, Cavalcanti JL, Strom EA, Perkins GH, Oh JL, Tereffe W, et al. Risk of subclinical micrometastatic disease in the supraclavicular nodal bed according to the anatomic distribution in patients with advanced breast cancer. Int J Radiat Oncol Biol Phys. 2008;71(2):435–40.CrossRefPubMedPubMedCentral
17.
go back to reference Veronesi U, Marubini E, Mariani L, Valagussa P, Zucali R. The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomised trial. Eur J Cancer. 1999;35(9):1320–5.CrossRefPubMed Veronesi U, Marubini E, Mariani L, Valagussa P, Zucali R. The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomised trial. Eur J Cancer. 1999;35(9):1320–5.CrossRefPubMed
18.
go back to reference Lacour J, Le M, Caceres E, Koszarowski T, Veronesi U, Hill C. Radical mastectomy versus radical mastectomy plus internal mammary dissection. Ten year results of an international cooperative trial in breast cancer. Cancer. 1983;51(10):1941–3.CrossRefPubMed Lacour J, Le M, Caceres E, Koszarowski T, Veronesi U, Hill C. Radical mastectomy versus radical mastectomy plus internal mammary dissection. Ten year results of an international cooperative trial in breast cancer. Cancer. 1983;51(10):1941–3.CrossRefPubMed
19.
go back to reference Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med. 1997;337(14):949–55.CrossRefPubMed Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med. 1997;337(14):949–55.CrossRefPubMed
20.
go back to reference Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005;97(2):116–26.CrossRefPubMed Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005;97(2):116–26.CrossRefPubMed
21.
go back to reference Overgaard M, Jensen M-B, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet. 1999;353(9165):1641–8.CrossRefPubMed Overgaard M, Jensen M-B, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet. 1999;353(9165):1641–8.CrossRefPubMed
22.
go back to reference Taghian A, Jeong J-H, Mamounas E, Anderson S, Bryant J, Deutsch M, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol. 2004;22(21):4247–54.CrossRefPubMed Taghian A, Jeong J-H, Mamounas E, Anderson S, Bryant J, Deutsch M, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol. 2004;22(21):4247–54.CrossRefPubMed
23.
go back to reference Overgaard M, editor. Overview of randomized trials in high risk breast cancer patients treated with adjuvant systemic therapy with or without postmastectomy irradiation. Seminars in radiation oncology. Elsevier; 1999. Overgaard M, editor. Overview of randomized trials in high risk breast cancer patients treated with adjuvant systemic therapy with or without postmastectomy irradiation. Seminars in radiation oncology. Elsevier; 1999.
24.
go back to reference Ashikaga T, Krag DN, Land SR, Julian TB, Anderson SJ, Brown AM, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102(2):111.CrossRefPubMedPubMedCentral Ashikaga T, Krag DN, Land SR, Julian TB, Anderson SJ, Brown AM, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102(2):111.CrossRefPubMedPubMedCentral
25.
go back to reference Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349(6):546–53.CrossRefPubMed Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349(6):546–53.CrossRefPubMed
26.
go back to reference Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33.CrossRefPubMedPubMedCentral Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33.CrossRefPubMedPubMedCentral
27.
go back to reference Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98(9):599–609.CrossRefPubMed Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98(9):599–609.CrossRefPubMed
28.
go back to reference Land SR, Kopec JA, Julian TB, Brown AM, Anderson SJ, Krag DN, et al. Patient-reported outcomes in sentinel node–negative adjuvant breast cancer patients receiving sentinel-node biopsy or axillary dissection: National Surgical Adjuvant Breast and Bowel Project Phase III Protocol B-32. J Clin Oncol. 2010;28(25):3929–36.CrossRefPubMedPubMedCentral Land SR, Kopec JA, Julian TB, Brown AM, Anderson SJ, Krag DN, et al. Patient-reported outcomes in sentinel node–negative adjuvant breast cancer patients receiving sentinel-node biopsy or axillary dissection: National Surgical Adjuvant Breast and Bowel Project Phase III Protocol B-32. J Clin Oncol. 2010;28(25):3929–36.CrossRefPubMedPubMedCentral
29.
go back to reference Chen T, Jonsson SH, Lenner P. Effect of mammographic service screening on stage at presentation of breast cancers in Sweden. Cancer. 2007;109(11):2205–12.CrossRef Chen T, Jonsson SH, Lenner P. Effect of mammographic service screening on stage at presentation of breast cancers in Sweden. Cancer. 2007;109(11):2205–12.CrossRef
30.
go back to reference Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75.CrossRefPubMed Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75.CrossRefPubMed
31.
go back to reference Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23–01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297–305.CrossRefPubMedPubMedCentral Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23–01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297–305.CrossRefPubMedPubMedCentral
32.
go back to reference Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426–33.PubMed Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426–33.PubMed
33.
go back to reference Gainer SM, Hunt KK, Beitsch P, Caudle AS, Mittendorf EA, Lucci A. Changing behavior in clinical practice in response to the ACOSOG Z0011 trial: a survey of the American Society of Breast Surgeons. Ann Surg Oncol. 2012;19(10):3152–8.CrossRefPubMed Gainer SM, Hunt KK, Beitsch P, Caudle AS, Mittendorf EA, Lucci A. Changing behavior in clinical practice in response to the ACOSOG Z0011 trial: a survey of the American Society of Breast Surgeons. Ann Surg Oncol. 2012;19(10):3152–8.CrossRefPubMed
34.
go back to reference Massimino KP, Hessman CJ, Ellis MC, Naik AM, Vetto JT. Impact of American College of Surgeons Oncology Group Z0011 and National Surgical Adjuvant Breast and Bowel Project B-32 trial results on surgeon practice in the Pacific Northwest. Am J Surg. 2012;203(5):618–22.CrossRefPubMed Massimino KP, Hessman CJ, Ellis MC, Naik AM, Vetto JT. Impact of American College of Surgeons Oncology Group Z0011 and National Surgical Adjuvant Breast and Bowel Project B-32 trial results on surgeon practice in the Pacific Northwest. Am J Surg. 2012;203(5):618–22.CrossRefPubMed
35.
go back to reference Caudle AS, Hunt KK, Tucker SL, Hoffman K, Gainer SM, Lucci A, et al. American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol. 2012;19(10):3144–51.CrossRefPubMedPubMedCentral Caudle AS, Hunt KK, Tucker SL, Hoffman K, Gainer SM, Lucci A, et al. American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol. 2012;19(10):3144–51.CrossRefPubMedPubMedCentral
37••.
go back to reference Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10. This randomized control trial demonstrated equivalent rates of axillary control with either axillary lymph node dissection or axillary radiation in women with positive sentinel node(s), with significantly less lymphedema following axillary radiation.CrossRefPubMedPubMedCentral Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10. This randomized control trial demonstrated equivalent rates of axillary control with either axillary lymph node dissection or axillary radiation in women with positive sentinel node(s), with significantly less lymphedema following axillary radiation.CrossRefPubMedPubMedCentral
38.
go back to reference Bouganim N, Tsvetkova E, Clemons M, Amir E. Evolution of sites of recurrence after early breast cancer over the last 20 years: implications for patient care and future research. Breast Cancer Res Treat. 2013;139(2):603–6. doi:10.1007/s10549-013-2561-7.CrossRefPubMed Bouganim N, Tsvetkova E, Clemons M, Amir E. Evolution of sites of recurrence after early breast cancer over the last 20 years: implications for patient care and future research. Breast Cancer Res Treat. 2013;139(2):603–6. doi:10.​1007/​s10549-013-2561-7.CrossRefPubMed
39.
go back to reference EBCTCG. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687–717.CrossRef EBCTCG. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687–717.CrossRef
40••.
go back to reference Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373(4):307–16. This is one of two randomized clinical trials demonstrating the benefit of regional nodal irradiation in patients at moderate to high risk based on involved axillary nodes or high risk node negative disease.CrossRefPubMedPubMedCentral Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373(4):307–16. This is one of two randomized clinical trials demonstrating the benefit of regional nodal irradiation in patients at moderate to high risk based on involved axillary nodes or high risk node negative disease.CrossRefPubMedPubMedCentral
41••.
go back to reference Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373(4):317–27. This is one of two randomized clinical trials demonstrating the benefit of regional nodal irradiation in patients at moderate to high risk based on involved axillary nodes or high risk node negative disease.CrossRefPubMed Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373(4):317–27. This is one of two randomized clinical trials demonstrating the benefit of regional nodal irradiation in patients at moderate to high risk based on involved axillary nodes or high risk node negative disease.CrossRefPubMed
42.
go back to reference Kaija H, Maunu P. Tangential breast irradiation with or without internal mammary chain irradiation: results of a randomized trial. Radiother Oncol. 1995;36(3):172–6.CrossRefPubMed Kaija H, Maunu P. Tangential breast irradiation with or without internal mammary chain irradiation: results of a randomized trial. Radiother Oncol. 1995;36(3):172–6.CrossRefPubMed
43.
go back to reference Hennequin C, Bossard N, Servagi-Vernat S, Maingon P, Dubois J-B, Datchary J, et al. Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy. Int J Radiat Oncol Biol Phys. 2013;86(5):860–6.CrossRefPubMed Hennequin C, Bossard N, Servagi-Vernat S, Maingon P, Dubois J-B, Datchary J, et al. Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy. Int J Radiat Oncol Biol Phys. 2013;86(5):860–6.CrossRefPubMed
44.
go back to reference Thorsen LBJ, Offersen BV, Danø H, Berg M, Jensen I, Pedersen AN, et al. DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol. 2015. doi:10.1200/JCO.2015.636456.PubMed Thorsen LBJ, Offersen BV, Danø H, Berg M, Jensen I, Pedersen AN, et al. DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol. 2015. doi:10.​1200/​JCO.​2015.​636456.PubMed
45••.
go back to reference Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Bronnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368(11):987–98. doi:10.1056/NEJMoa1209825. This population-based case-control study demonstrated the relationship between estimated radiation doses to the heart and ischemic cardiac disease.CrossRefPubMed Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Bronnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368(11):987–98. doi:10.​1056/​NEJMoa1209825. This population-based case-control study demonstrated the relationship between estimated radiation doses to the heart and ischemic cardiac disease.CrossRefPubMed
46.
go back to reference Madu CN, Quint DJ, Normolle DP, Marsh RB, Wang EY, Pierce LJ. Definition of the supraclavicular and infraclavicular nodes: implications for three-dimensional CT-based conformal radiation therapy 1. Radiology. 2001;221(2):333–9.CrossRefPubMed Madu CN, Quint DJ, Normolle DP, Marsh RB, Wang EY, Pierce LJ. Definition of the supraclavicular and infraclavicular nodes: implications for three-dimensional CT-based conformal radiation therapy 1. Radiology. 2001;221(2):333–9.CrossRefPubMed
47.
go back to reference Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Sola AB, et al. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol. 2015;114(1):3–10.CrossRefPubMed Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Sola AB, et al. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol. 2015;114(1):3–10.CrossRefPubMed
48.
go back to reference Chung E, Corbett JR, Moran JM, Griffith KA, Marsh RB, Feng M, et al. Is there a dose-response relationship for heart disease with low-dose radiation therapy? Int J Radiat Oncol Biol Phys. 2013;85(4):959–64.CrossRefPubMed Chung E, Corbett JR, Moran JM, Griffith KA, Marsh RB, Feng M, et al. Is there a dose-response relationship for heart disease with low-dose radiation therapy? Int J Radiat Oncol Biol Phys. 2013;85(4):959–64.CrossRefPubMed
49.
go back to reference Warren LE, Miller CL, Horick N, Skolny MN, Jammallo LS, Sadek BT, et al. The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: a prospective cohort study. Int J Radiat Oncol Biol Phys. 2014;88(3):565–71.CrossRefPubMedPubMedCentral Warren LE, Miller CL, Horick N, Skolny MN, Jammallo LS, Sadek BT, et al. The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: a prospective cohort study. Int J Radiat Oncol Biol Phys. 2014;88(3):565–71.CrossRefPubMedPubMedCentral
51.
go back to reference Burstein HJ, Morrow M. Nodal irradiation after breast-cancer surgery in the era of effective adjuvant therapy. N Engl J Med. 2015;373(4):379–81.CrossRefPubMed Burstein HJ, Morrow M. Nodal irradiation after breast-cancer surgery in the era of effective adjuvant therapy. N Engl J Med. 2015;373(4):379–81.CrossRefPubMed
52.
go back to reference Poortmans P, Whelan T. Locoregional treatment in early stage breast cancer: more evidence and yet more questions? Clin Oncol. 2015;27(12):689–91.CrossRef Poortmans P, Whelan T. Locoregional treatment in early stage breast cancer: more evidence and yet more questions? Clin Oncol. 2015;27(12):689–91.CrossRef
53.
go back to reference Mamounas EP, Anderson SJ, Dignam JJ, Bear HD, Julian TB, Geyer CE, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol. 2012;30(32):3960–6.CrossRefPubMedPubMedCentral Mamounas EP, Anderson SJ, Dignam JJ, Bear HD, Julian TB, Geyer CE, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol. 2012;30(32):3960–6.CrossRefPubMedPubMedCentral
Metadata
Title
Regional Nodal Radiotherapy in Early-Stage Breast Cancer: Where Are We in 2016?
Authors
Robert T. Dess
Corey W. Speers
Lori J. Pierce
Publication date
01-06-2016
Publisher
Springer US
Published in
Current Breast Cancer Reports / Issue 2/2016
Print ISSN: 1943-4588
Electronic ISSN: 1943-4596
DOI
https://doi.org/10.1007/s12609-016-0209-4

Other articles of this Issue 2/2016

Current Breast Cancer Reports 2/2016 Go to the issue

Local-Regional Evaluation and Therapy (EP Mamounas, Section Editor)

The Optimal Approach to Post-Mastectomy and Post-Lumpectomy Breast Reconstruction

Local-Regional Evaluation and Therapy (EP Mamounas, Section Editor)

Nipple-Sparing Mastectomy in Patients with Germline BRCA Mutations: Is it Safe?

Local-Regional Evaluation and Therapy (EP Mamounas, Section Editor)

Role of Breast MRI in Patients with Newly Diagnosed Breast Cancer

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine