Top

Published in:

01-12-2015 | REVIEW ARTICLE

Management of Axilla in 2015 in Indian Scenario

Authors: D. K. Vijaykumar, M. Arunlal

Published in: Indian Journal of Surgical Oncology | Issue 4/2015

Abstract

Sentinel lymph node biopsy is now increasingly being considered the favored method to treat low volume axilla. Most often this is followed by adjuvant radiation directed at axilla. In India however, sentinel node itself is still not widely practiced. The radiotherapy facilities are also not uniform, with cobalt units still being used in many centers. The long-term complications related to radiation are not assessed well. In fact there are also questions whether the evidence from early screen detected cancers in western population can be blindly followed in our population with a possibly different tumor biology and presentation as locally advanced being the norm. However, it is possible that we will see lesser axillary surgery in the minimal axillary disease group, in the not so distant future. We will look at the emerging evidence with an open mind and try to look at how this is applicable to our scenario.

Fisher B, Jeong JH, Anderson S et al (2002) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 347:567–575CrossRefPubMed

Martelli G, Boracchi P, De Palo M et al (2005) A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: results after 5 years of follow up. Ann Surg 242:1–6CrossRefPubMedPubMedCentral

Rudenstam CM, Zahrieh D, Forbes JF et al (2006) Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: First results of International Breast Cancer Study Group Trial 10–93. J Clin Oncol 24:337–344CrossRefPubMed

Xie L, Higginson DS, Marks LB (2011) Elective regional nodal irradiation in patients with early-stage breast cancer. Semin Radiat Oncol 21(1):66–78

Mansel RE, Fallowfield L, Kissin M, Goyal A et al (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. JNCI J Natl Cancer Inst 98(9):599–609CrossRefPubMed

Veronesi U, Viale G, Paganelli G, Zurrida S et al (2009) Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg Oncol 16(2):266–275CrossRef

Wetzig N, Gill PG, Zannino D, Stockler MR (2015) Sentinel lymph node based management or routine axillary clearance? Three-year outcomes of the RACS sentinel node biopsy versus axillary clearance (SNAC) 1 trial. Ann Surg Oncol 22(1):17–23. doi:10.1245/s10434-014-3928-7 CrossRefPubMed

Krag DN, Anderson SJ, Julian TB, Brown AM et al (2010) 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 randomized phase 3 trial. Lancet Oncol 11(10):927e33CrossRef

Giuliano AE, Hunt KK, Ballman KV, Beitsch PD et al (2011) Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 305(6):569–575

10.

Giuliano AE, McCall L, Beitsch P et al (2010) Loco regional 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 252(3):426–433PubMed

11.

Lucci A, McCall LM, Beitsch PD et al (2007) American College of Surgeons Oncology Group. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group trial Z0011. J Clin Oncol 25(24):3657–3663CrossRefPubMed

12.

Galimberti V, Cole BF, Zurrida S et al (2013) IBCSG 23–01 randomized controlled trial comparing axillary dissection versus no axillary dissection in patients with sentinel node micro metastases. Lancet Oncol 14(4):297–305CrossRefPubMedPubMedCentral

13.

Solá M, Alberro JA, Fraile M, Santesteban P et al (2013) Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micro metastasis: final results from the multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol 20(1):120–127CrossRefPubMed

14.

Savolt A, Matrai Z, Polgar CS, Udvarhelyi N et al (2013) Optimal treatment of the axilla after positive sentinel lymph node biopsy in primary invasive breast cancer patients (surgery versus radiotherapy) OTOASOR trial: 5 years follow-up of a randomized clinical trial. Orv Hetil 154(49):1934–1942CrossRefPubMed

15.

Donker M, van Tienhoven G, Straver ME, Meijnen P et al (2014) Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomized, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 15(12):1303–1310CrossRefPubMedPubMedCentral

16.

Alco G, Dincer M (2013) Are the standard tangential breast irradiation fields used in the ACOSOG Z0011 trial really covering the entire axilla? Ann Surg 257:e1CrossRefPubMed

17.

Giuliano AE (2013) Reply to letter: Are the standard tangential breast irradiation fields used in the ACOSOG Z0011 trial really covering the entire axilla? Ann Surg 257:e2CrossRefPubMed

18.

Jagsi R, Chadha M, Moni J, Ballman K et al (2014) Radiation field design in the ACOSOG Z0011 (Alliance) trial. J Clin Oncol 32(32):3600–3606

19.

Schlembach PJ, Buchholz TA, Ross MI et al (2001) Relationship of sentinel and axillary level I-II lymphnodes to tangential fields used in breast irradiation. Int J Radiat Oncol Biol Phys 51:671–678

20.

Reznik J, Cicchetti MG, Degaspe B et al (2005) Analysis of axillary coverage during tangential radiotherapy to the breast. Int J Radiat Oncol Biol Phys 61:163–168CrossRefPubMed

21.

Sávolt Á, Polgár C, Musonda P, Mátrai Z et al (2013) Does the result of completion axillary lymph node dissection influence the recommendation for adjuvant treatment in sentinel lymph node positive patients? Clin Breast Cancer 13(5):364–370CrossRefPubMed

22.

Overgaard M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b trial. N Engl J Med 337:949–955CrossRefPubMed

23.

Overgaard M, Jensen MB, Overgaard J et al (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen DBCG, Danish Breast Cancer Cooperative Group 82c randomized trial. Lancet 353:1641–1648CrossRefPubMed

24.

Ragaz J, Olivotto IA, Spinelli JJ et al (2005) 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 97:116–126CrossRefPubMed

25.

Poortmans PM, Collette S, Kirkove C, Van Limbergen E (2015) Internal mammary and medial supraclavicular irradiation in breast EORTC radiation oncology and breast cancer groups. N Engl J Med 373:317–327CrossRefPubMed

26.

Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, MA.20 Study (2015) Regional Nodal Irradiation in Early-Stage Breast Cancer. N Engl J Med 373:307–316CrossRefPubMedPubMedCentral

Title: Management of Axilla in 2015 in Indian Scenario
Authors: D. K. Vijaykumar
M. Arunlal
Publication date: 01-12-2015
Publisher: Springer India
Published in: Indian Journal of Surgical Oncology / Issue 4/2015
Print ISSN: 0975-7651
Electronic ISSN: 0976-6952
DOI: https://doi.org/10.1007/s13193-015-0466-0

At a glance: The STEP trials

Springer Medicine

Management of Axilla in 2015 in Indian Scenario

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2015

Pedicled TRAM Flap in Presence of Desmoid Tumor of the Rectus Sheath; a Case Report

Bilateral Mastectomy for Unilateral Breast Cancer: a Perplexing Trend

Granular Cell Tumor of Breast: a Case Report and Review of Literature

Male Breast Cancer in India: Series from a Cancer Research Centre

Decreased Expression of BRCA2 Accelerates Sporadic Breast Cancer Progression

Correlation of Various Biomarkers with Axillary Nodal Metastases: Can a Panel of Such Biomarkers Guide Selective Use of Axillary Surgery in T1 Breast Cancer?