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. 2019 Dec;11(4):293-302.
doi: 10.1007/s12609-019-00330-6. Epub 2019 Sep 14.

A Radiation Oncologist's Guide to Axillary Management in Breast Cancer: A Walk Through the Trials

Julie K Jang  1 , Elana R Sverdlik  2 , Naomi R Schechter  1
Affiliations

A Radiation Oncologist's Guide to Axillary Management in Breast Cancer: A Walk Through the Trials

Julie K Jang et al. Curr Breast Cancer Rep. 2019 Dec.

Erratum in

Abstract

Purpose of review: The axilla is the most common site for breast cancer nodal metastases. Aggressive management includes axillary lymph node dissection (ALND), radiotherapy, and systemic therapy, but carries the risks of lymphedema and "overtreatment". We review the clinical trials that led to de-escalation of axillary management and their nuances that are often overlooked.

Recent findings: With the rise of sentinel lymph node biopsy, several trials conclude that ALND can be omitted in specific populations. However, the subtleties in those trials, such as the role of chemotherapy and radiotherapy, have yet to be clarified. These discussions carry forward into the era of neoadjuvant chemotherapy, where ongoing trials investigate who needs ALND and/or radiation.

Summary: This review examines the clinical trials that form the standard of care, and highlights why axillary management is individualized today.

Keywords: axilla; axillary lymph node dissection; breast cancer; lymph node metastasis; radiotherapy; sentinel lymph node biopsy.

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Conflict of interest statement

Conflict of Interest Julie Jang, Elana Sverdlik, and Naomi Schechter declare no conflicts of interest relevant to this manuscript.

Figures

Figure 1.
Figure 1.. Coverage of axillary lymph nodes with different breast radiation fields.
Standard tangent fields coverage in axial (A) and coronal views (B). Standard anterior oblique or “supraclavicular/axillary apex field (SCV)” coverage (C). “High” tangent fields coverage (D). Axillary level I is shown in red, level II in yellow, and level III in blue. In this individual, standard tangent fields cover most of axillary level I and a small portion of level II. The SCV field is often added/matched to standard tangent fields in order to complete treatment of higher axillary level II and axillary level III lymph nodes. Alternatively, if no SCV field is used, the superior border of the tangent fields may be elevated to cover more of level II than would be covered with standard tangents alone.
See this image and copyright information in PMC

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