Department of Radiation Oncology, IRCCS Policlinico San Martino, Genoa, Italy.
Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Italy.
Expert Rev Anticancer Ther. 2021 Aug;21(8):827-840. doi: 10.1080/14737140.2021.1917390. Epub 2021 Apr 25.
: Sentinel lymph node biopsy (SLNB) is the gold standard in invasive breast cancer. Axillary dissection (ALND) is controversial in some presentations.: Key questions were formulated and explored focused on four different scenarios in adjuvant axillary radiation management in early and locally advanced breast cancer. Answers to these questions were searched in MEDLINE, PubMed from June 1946 to August 2020. Clinical trials, retrospective studies, international guidelines, meta-analysis, and reviews were explored.: Analysis according to biological disease characteristics is necessary to establish the impact of ALND avoidance in unexpectedly positive SLNB (pN1) in cN0 patients. A low-risk probability of axillary recurrence was observed if axillary radiotherapy (ART) or ALND were offered without impact on outcomes. Adjuvant RNI in pT1-3 pN1 treated with mastectomy or BCS should be proposed in unfavorable disease and risk factors. In ycN0 after NACT, SLNB can be offered in selected cases or ALND should be performed. After SLNB post-NACT (ypN1), ALND and adjuvant radiotherapy are mandatory.
前哨淋巴结活检（SLNB）是浸润性乳腺癌的金标准。在某些情况下，腋窝清扫（ALND）存在争议。
主要问题是针对早期和局部晚期乳腺癌辅助腋窝放疗管理的四种不同情况进行制定和探讨。这些问题的答案在 MEDLINE、PubMed 中进行了检索，检索时间为 1946 年 6 月至 2020 年 8 月。临床试验、回顾性研究、国际指南、荟萃分析和综述都进行了探讨。
根据生物学疾病特征进行分析，对于在 cN0 患者中意外出现阳性 SLNB（pN1）时避免 ALND 的影响是必要的。如果不影响结果，则提供腋窝放疗（ART）或 ALND，观察到腋窝复发的低风险概率。对于接受乳房切除术或 BCS 治疗的 pT1-3 pN1 患者，应在疾病和危险因素不利的情况下提出辅助放射性碘治疗（RNI）。在新辅助化疗（NACT）后的 ycN0 中，可以在选定的情况下提供 SLNB，或应进行 ALND。在 NACT 后 SLNB（ypN1）后，ALND 和辅助放疗是强制性的。
