Chadha M, Axelrod D
Department of Radiation Oncology, Beth Israel Medical Center, New York, New York, USA.
Oncology (Williston Park). 1997 Oct;11(10):1463-8; discussion 1468, 1473-9.
In light of the changing trends in the diagnosis and management of invasive breast cancer, the practice of routine axillary dissection should be reevaluated. A growing number of patients with breast cancer are diagnosed as having small tumors with an associated low risk of lymph node metastases. The pathologic features of the primary tumor are increasingly being used as a prognostic guide for recommendations about adjuvant systemic therapy, and there are recent reports suggesting a superior prognostic value for tumor cells detected in bone marrow, as compared to axillary lymph node metastases. Consequently, axillary lymph node status is no longer the single prognostic guide for recommendations about adjuvant systemic therapy. For treatment of the axilla, there is evidence that, in clinical N0 patients, radiation therapy to the axilla is an effective alternative to axillary dissection. Finally, there are cost and morbidity considerations for patients undergoing axillary dissection in whom the indications of the procedure are equivocal. In the management of invasive breast cancer, a selective policy toward axillary lymph node dissection should be considered. This review discusses the nonsurgical management of the axilla; ie, radiation therapy to the axilla and observation of the axilla as an alternative to axillary dissection.
鉴于浸润性乳腺癌诊断和治疗趋势的变化，常规腋窝淋巴结清扫术的做法应重新评估。越来越多的乳腺癌患者被诊断为肿瘤较小且淋巴结转移风险较低。原发肿瘤的病理特征越来越多地被用作辅助全身治疗建议的预后指导，并且最近有报告表明，与腋窝淋巴结转移相比，骨髓中检测到的肿瘤细胞具有更高的预后价值。因此，腋窝淋巴结状态不再是辅助全身治疗建议的唯一预后指导。对于腋窝的治疗，有证据表明，在临床N0患者中，腋窝放疗是腋窝清扫术的有效替代方法。最后，对于手术指征不明确的接受腋窝清扫术的患者，还需要考虑成本和发病率。在浸润性乳腺癌的治疗中，应考虑对腋窝淋巴结清扫采取选择性策略。本综述讨论了腋窝的非手术治疗；即腋窝放疗以及观察腋窝作为腋窝清扫术的替代方法。
