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Breast Cancer • Radiation Oncology
What pathological factors do you use to consider treatment of the axillary level I/II after an axillary dissection?
How do you define an “adequate” axillary dissection, (i.e., would 8 lymph nodes dissection instead of 10 be “adequate”), or change your recommendation on axilla treatment pending other pathological factors?
Would matted nodes and ECE be an indication?
Would the percent of nodes positive be an indication for axillary treatment?
Answer from: Radiation Oncologist at Academic Institution
We examined the risk of axillary failure in relation to the number of positive nodes AND the number of nodes removed by axillary dissection for patients undergoing mastectomy without PMRT in ECOG patients treated with chemotherapy in trials conducted from 1972-1987 (Recht et al., PMID 10561205). Wit...
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Answer from: Radiation Oncologist at Academic Institution
I think this is an area that is evolving. I consider treatment of level I/II for the following ALND:
4+ LN
ECE (some controversy of microscopic vs. gross ECE), matted nodes
Inadequate dissection < 6-8 LN (number not well defined)
Disease in axillary fat/tissue
Can consider based on % of ...
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Radiation Oncologist at West Virginia University
A couple of issues regarding Dr. @Chirag S. Shah's...
A couple of issues regarding Dr. @Chirag S. Shah's...
Answer from: Radiation Oncologist at Academic Institution
In Ax LN positive patients, the classic teaching years ago was to essentially not treat the dissected axilla if the surgeon did a formal dissection. I am not aware of any data saying that ECE is predictive for Ax recurrence. As I recall, the old data on ECE was that it was a predictor for overall ba...
Answer from: Radiation Oncologist at Community Practice
Unfortunately, almost all studies quoting axillary recurrence after PMRT or RNI are also confounded by the inclusion of some or all of dissected axilla in tangent beam and underreporting of recurrence because of routine imaging and association with distant recurrence.