¿Cuándo hay que irradiar los ganglios después de cirugía primaria?

Abstract

Radiotherapy is one of the basic mainstays of breast cancer's treatment. Nodal irradiation, including axillary, supraclavicular nodes, and internal mammary chain, is as important as the primary tumor. There is a broad consensus on the need for breast volume irradiation after conservative surgery and chest wall after mastectomy. However, regarding the nodal irradiation, there has been a continuing controversy for some years, which has increased since the abandonment of axillary lymphadenectomy in cases of low burden disease at this level. There are several studies suggesting the need or not for nodal irradiation, although many of them have the problem of not describing the received radiation dose at these levels, and so decision-making is complex. Once it has been decided that the patient is a candidate for irradiation, the second question refers to the lymph node volumes that must be treated. Finally it is necessary to determine which therapeutic scheme must be administered. In these two points, despite the existence of a higher level of evidence as well there is also controversy. This article reviews the usefulness of nodal irradiation, as well as the volumes to be irradiated and the fractionation to be used, making a therapeutic proposal.