Locoregional Management of Early-Stage Breast Cancer

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Locoregional management of early-stage breast cancer has been trending toward less-extensive axillary resections, based on increasing evidence showing that patients with 1 or 2 positive sentinel nodes and/or micrometastases can safely be managed with sentinel node biopsy alone, thereby avoiding complete axillary lymph node dissection (cALND) in the significant majority of patients. Because of the 15% to 20% lymphedema risk associated with cALND, increasing efforts are being made to avoid the procedure when evidence suggests that more limited procedures are safe, as reflected by acceptable locoregional recurrence rates. Axillary radiotherapy (RT) has been shown to be an effective alternative to ALND for patients fitting criteria from the pivotal AMAROS trial: patients with T1/T2 disease and are clinically node-negative, who undergo either breast-conserving therapy or mastectomy. Considerations for RT begin with the question of nodal involvement, with treatment planned accordingly. With more neoadjuvant therapy being used, there are nuances in locoregional management that clinicians must now appreciate, both in terms of ALND and axillary RT.

Disclosures: Dr. Anderson has disclosed that he received a consulting fee from Allergan and was a scientific advisor for UE LifeSciences. Dr. Lyons has disclosed that she has no relevant financial relationships.

Correspondence: Benjamin O. Anderson, MD, Departments of Surgery and Global Health, University of Washington, Box 356410, Seattle, WA 98195. Email: banderso@uw.edu; and Janice A. Lyons, MD, Department of Radiation Oncology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106. Email: janice.lyons@uhhospitals.org
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