Abstract
It is recognised that surgical conservatism is the most effective way of managing the axilla in breast cancer patients undergoing primary breast conserving surgery. The extended clinical scenarios in which a less aggressive approach can be safely adopted warrant consideration—including a group of patients who potentially could bypass surgical staging of the axilla altogether. The application of omission of further surgical management and axillary radiotherapy in the primary surgical and neoadjuvant chemotherapy settings are considered.
Highlights
Surgical axillary nodal status remains relevant for the determination of adjuvant systemic therapies in breast cancer
An added consideration to the change of practice heralded after Z11 come from the results of the AMAROS [12] trial which indicate that in patients with a positive sentinel node biopsy (SNB), axillary radiotherapy provides equivalent locoregional control when compared with axillary node clearance (ANC) and with less associated morbidity
The PRIMETIME trial includes SNB, and the conservative omission of completion axillary node clearance relies upon the patient receiving whole-breast radiotherapy
Summary
Surgical axillary nodal status remains relevant for the determination of adjuvant systemic therapies in breast cancer. For patients presenting with primary invasive breast cancer, current practice with regards to the axilla includes a clinical and radiological assessment (most commonly ultrasound) at the time of work up [4]. These results have shaped opinion and practice over the last decade [9] and in this patient group it is widely accepted that completion ANC is unnecessary [10]—with SNB being considered as therapeutic for low nodal burden axillary disease.
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