Axillary recurrence in breast cancer (original) (raw)
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Isolated axillary recurrences after conservative treatment of breast cancer
European Journal of Cancer, 1996
This retrospective study presents the diagnostic, prognostic and therapeutic problems raised by axillary recurrences (AR). 1589 cases of breast cancer measuring less than 3 cm, treated at the Institut Curie between 1981 and 1987, were studied by a combination of surgery and radiotherapy. Treatment of the breast always included wide local excision associated with irradiation. The axilla was treated either by dissection (865 cases) or by irradiation (724 cases) and 159 patients received chemotherapy. 26 patients (2%) developed AR, confirmed by fine needle aspiration cytology in 92% of cases. None of these 26 patients had initially received chemotherapy. The treatment of the AR was variable, adapted to the initial treatment. 22 patients retained their breast during treatment of the AR and none subsequently developed a local recurrence. 4 mastectomies were performed and histological examination revealed a subclinical local recurrence in 2 cases. The TNM classification, menopausal status, size of the tumour and hormonal receptor status were not risk factors for AR. Young age (P= 0.01) and high histological grade (P = 0.03) were significant risk factors for AR. The AR rate was similar whether axillary dissection or axillary irradiation had been performed. The overall 5-year survival after initial treatment was 85% for AR and 95% for the reference population. The overall 4-year survival after recurrence was 69% and the incidence of metastasis was markedly increased (P= 0.002). 2 of the 26 patients developed lymphoedema of the arm after treatment of AR. We confirm that AR worsens the prognosis, but not significantly more than local recurrence. Young age and the modified histological grading of ScarIf Bloom and Richardson were risk factors for AR. Although excision of the AR is necessary to ensure local control, mastectomy is unnecessary when clinical examination and mammography are normal.
Consequences of axillary recurrence after conservative breast surgery
British Journal of Surgery, 2002
Background: The aim was to study the incidence, time course and prognosis of patients who developed axillary recurrence after breast-conserving surgery, and to evaluate possible risk factors for axillary recurrence and prognostic factors after axillary recurrence.
Treatment of the axilla in early breast cancer: past, present and future
ANZ Journal of Surgery, 2001
Background : The optimal treatment of the axilla in early breast cancer is controversial. The present study reviews the pattern and predictors of regional recurrence (RR) and prognosis after RR in patients with early breast cancer treated by conservative surgery and radiotherapy (CS + RT). Implications of the results on current practice and future directions are explored. Methods : Between 1979 and 1994, 1158 patients with stage I or II breast cancer were treated with CS + RT at Westmead Hospital. Two groups of patients were compared: 782 patients who underwent axillary dissection (axillary surgery group) and 229 patients who received radiotherapy (axillary RT group) as the only axillary treatment. At least 10 lymph nodes were dissected in 82% of the axillary surgery group. Of the women in the RT group, 90% received RT to the axilla and supraclavicular fossa (SCF) only and 10% also received RT to the internal mammary chain (IMC). Results : With a median follow-up period of 79 months for the axillary surgery group and 111 months for the axillary RT group, 27 patients developed a RR (2.8% and 2.2%, respectively). Seven patients (0.9%) in the axillary surgery group and three patients (1.3%) in the axillary RT group developed a RR in the axilla (P , not significant). Of the patients with SCF recurrences, 14 (1.8%) were in the axillary surgery group and one (0.4%) in the axillary RT group (P , not significant). One patient in the axillary surgery group developed concurrent axillary and SCF recurrences, while a patient in the axillary RT group developed an IMC recurrence. Twenty (74%) of the 27 patients with a RR developed a concurrent or subsequent distant relapse (30% and 44%, respectively). In the pathologically node-positive patients, the axillary recurrence rate was higher in those who had less than five nodes removed (17%) than those who had 10 or more nodes removed (0%; P = 0.01). The SCF recurrence rate was higher in patients with four or more positive axillary nodes (9.5%) than in those with 0-3 positive nodes (1.5%; P = 0.003). Conclusion : Adequate treatment of the axilla by surgery or RT alone is associated with a low rate of RR. The incidence of distant relapse was substantial in patients who developed a RR, which gives emphasis to the importance of optimizing local-regional control.
Critical review of axillary recurrence in early breast cancer
Critical reviews in oncology/hematology, 2018
Around 2% of early breast cancer cases treated with axillary lymph node dissection (ALND) underwent axillary recurrence (AR) and it has a deleterious effect in prognosis. Different scenarios have incorporated Sentinel Lymph Node (SLN) Biopsy (SLNB) instead of ALND as part of the standard treatment and more effective systemic treatment has also been incorporated in routine management after first curative surgery and after regional recurrence. However, there is concern about the effect of SLNB alone over AR risk and how to predict and treat AR. SLN biopsy (SLNB) has been largely accepted as a valid option for SLN-negative cases, and recent prospective studies have demonstrated that it is also safe for some SLN-positive cases and both scenarios carry low AR rates. Different studies have identified clinicopathological factors related to aggressiveness as well as high-risk molecular signatures can predict the development of locoregional recurrence. Other publications have evaluated facto...
Position Statement on Management of the Axilla in Patients With Invasive Breast Cancer
Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) for the staging of clinically node-negative breast cancer patients, demonstrating equivalent survival to ALND for lymph node–negative patients 1 while resulting in reduced morbidity. 2 For the majority of patients with pathologically positive SLNs, completion ALND is recommended by the American Society of Clinical Oncology Guidelines and the National Comprehensive Cancer Network (NCCN). 3,4 However, recent data from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial suggest that ALND may be omitted in selected patients with 1 or 2 positive SLNs. 5,6 In the ACOSOG Z0011 trial, 813 patients with clinical T1-2 node-negative tumors who were found to have hematoxylin and eosin (H&E)-positive SLNs were randomized to ALND vs no further axillary surgery. Patients with palpable lymph nodes or clinical T3 tumors were not eligible for this study. The protocol mandated the use of standard whole-breast radiation without an axillary field. Patients with >3 positive SLNs were excluded from the study. The trial was closed early due to poor accrual with an enrollment of only 47% of the targeted 1900 patients. It still showed equivalent results between the 2 treatment arms for loco-regional failure and survival. At 6.3 years' follow-up, no differences were found between the 2 groups in the rates of axillary recurrence (0.5% vs 0.9%), in-breast recurrence (3.6% vs 1.9%), or overall locoregional recurrence (4.1% vs 2.8%, P = 0.53). 5 Disease-free and overall survival were similar (82.2% vs 83.8% and 91.9% vs 92.5%) between the groups. 6 The majority of women in this trial were older than 50 years (64%), had clinical T1 tumors (68%), had ER-positive tumors (77%), had only 1 positive SLN (60%), received whole-breast radiation (89%), and received systemic therapy (96%: 58% adjuvant chemotherapy and 46% adjuvant hormonal therapy). Forty percent of patients had micrometastases or isolated tumor cells and 60% had macrometastases in the sentinel nodes. Additional positive axillary nodes were found in 27.3% of the ALND patients. This study excluded patients undergoing mastectomy and patients receiving neoadjuvant chemotherapy.
Axillary surgery in breast cancer: An updated historical perspective
Seminars in Oncology
This historical surgical retrospection focuses on the temporal de-escalation axillary surgery, focusing on the unceasing effort s of researchers toward new challenges, as documented by extensive studies and trials. Axillary surgery has evolved, aiming to offer the best oncologic treatment and improve the quality of life of women. Axillary lymph-node dissection (ALND) has been replaced by sentinel lymphnode biopsy (SLNB) in women with early clinically node-negative breast cancer, providing adequate axillary nodal staging information with minimal morbidity, and becoming the standard of care in the management of breast cancer. However, this is only the beginning. Strategies in defining systemic and radiotherapeutic treatments have gradually been optimized, offering increasingly refined and targeted breast cancer treatment tools. In recent years, the paradigm of completion ALND after a positive SLNB has been questioned, and several studies have led to revolutionary changes in clinical practice. Moreover, the increasingly pivotal role played by neoadjuvant chemotherapy (NAC) has had a profound effect on the extent of axillary surgery, paving the way to a more finite "targeted" procedure in women with node-positive breast cancer who convert to negative nodes clinically after NAC. The utility of SLNB itself and its subsequent omission in women with negative nodes clinically and breast conservative surgery is also under scientific evaluation. The changes over time in the surgical approach to breast cancer have been numerous and significant. The novel emerging perspective characterized by recent advances in biology and genetics, in dedicated axillary ultrasound imaging and chemotherapy regimens, is the present reality that points to the future of axillary node treatment in breast cancer.
2021
Background: To evaluate and compare overall survival and locoregional recurrence between patients with invasive breast tumors and sentinel node metastasis undergoing sentinel lymph node dissection (SLND) alone and those undergoing complete axillary lymph node dissection (ALND).Methods: In this retrospective cohort study, we reviewed medical records of all consecutive patients with primary invasive breast carcinoma who had undergone conservative surgery at a public university hospital in Brazil between 2008 and 2018. We evaluated the overall survival and the onset of locoregional recurrence using Kaplan-Meier and Cox regression analyses, respectively. Results: Overall, 97 participants underwent conservative breast surgery, 41 in the ALND group, and 56 in the SLND group. The mean age was 57.8 years. Only 17% of the patients in the ALND group had an additional biopsy-proven axillary disease, and 83% were treated with complete dissection unnecessarily. The 5-year survival rates were 80....
A Radiation Oncologist’s Guide to Axillary Management in Breast Cancer: a Walk Through the Trials
Current Breast Cancer Reports, 2019
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.