Highlights
- •Efforts continue to distinguish conditions where axillary interventions may be minimized to reduce therapeutic morbidity.
- •The appropriateness of regional nodal RT vs ALND for pN+ in the upfront mastectomy setting can pose a challenging dilemma.
- •Several multicenter studies are investigating the oncologic safety of less invasive axillary staging techniques after NAC.
- •Upfront surgery treatment algorithms may be a more congruent approach to management after neoadjuvant endocrine therapy.
Abstract
Over the past decade, axillary management in breast cancer has fundamentally shifted.
The former notion that any degree of axillary nodal involvement warrants axillary
lymph node dissection (ALND) has been challenged. Following publication of the ACOSOG
Z0011 trial, national trends demonstrated significant reductions in ALND performance.
Axillary radiotherapy in lieu of ALND is a consideration for select patients with
a positive sentinel lymph node, while ongoing studies are investigating the role of
adjuvant regional radiotherapy in women with positive nodes prior to neoadjuvant chemotherapy.
Efforts toward de-escalation of axillary surgery continue to evolve, as do the indications
for sentinel node biopsy omission in select subsets of patients. This review highlights
the recent advances and neoteric approaches to local therapy of the axilla in breast
cancer.
Keywords
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Article info
Publication history
Published online: December 02, 2022
Accepted:
November 29,
2022
Received:
August 29,
2022
Identification
Copyright
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