Document Detail

How do I deal with the axilla in patients with a positive sentinel lymph node?
MedLine Citation:
PMID:  21979858     Owner:  NLM     Status:  MEDLINE    
Optimal management of the axilla in a patient with a positive sentinel node biopsy is not yet defined.These patients usually have Breast Conserving Surgery and receive adjuvant systemic therapy and whole breast radiation.Treatment options for the axilla include: no further surgery with or without radiation completion axillary nodal dissection with or without radiation Radiation options in addition to whole breast radiation include axillary and supraclavicular nodal irradiation regional nodal irradiationincludes supraclavicular and internal mammary nodes Completion axillary dissection has been standard practice in patients with positive sentinel nodes. the number of involved nodes provides prognostic information. theoretically improves local control, but may be obviated by systemic chemotherapy. but avoidance of dissection may not adversely affect locoregional control or survival. dissection has significant morbidity so safe avoidance is desirable. There is little worldwide concordance on the use of radiation: whole breast radiation (commonly used after breast conserving surgery) may radiate the lower axilla supraclavicular radiation is most commonly recommended for patients with four or more nodes but may confer a survival benefit on patients with lower risk disease. adding nodal irradiation reduces local recurrence with only modest toxicity. Adjuvant systemic therapy provides a survival benefit for patients with nodal disease. Most will receive cytostatic chemotherapy containing an anthracycline and a taxane. Hormone therapy is appropriate for estrogen receptor positive disease. The extent to which systemic therapy controls microscopic nodal disease is unknown. Node positive patients should generally receive adjuvant chemotherapy.A small group of patients benefit from specific nodal therapy. Further studies are needed to better identify these patients.
Conrad B Falkson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current treatment options in oncology     Volume:  12     ISSN:  1534-6277     ISO Abbreviation:  Curr Treat Options Oncol     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-14     Completed Date:  2012-03-09     Revised Date:  2013-07-25    
Medline Journal Info:
Nlm Unique ID:  100900946     Medline TA:  Curr Treat Options Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  389-402     Citation Subset:  IM    
Department of Oncology, Queen's University and CCSEO at Kingston General Hospital, Ontario, Canada.
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MeSH Terms
Breast Neoplasms / pathology,  radiotherapy,  surgery,  therapy*
Lymph Nodes / pathology*
Sentinel Lymph Node Biopsy
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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