Original Article

You have full text access to this OnlineOpen article

Treatment of breast carcinoma in patients with clinically negative axillary lymph nodes using radiotherapy versus axillary dissection†

  1. Naoko Fujimoto M.D.1,‡,*,
  2. Atsushi Amemiya M.D.1,
  3. Makoto Kondo M.D.2,
  4. Atsuya Takeda M.D.2,
  5. Naoyuki Shigematsu M.D.2

Article first published online: 8 OCT 2004

DOI: 10.1002/cncr.20650

Issue

Cancer

Cancer

Volume 101, Issue 10, pages 2155–2163, 15 November 2004

Additional Information

How to Cite

Fujimoto, N., Amemiya, A., Kondo, M., Takeda, A. and Shigematsu, N. (2004), Treatment of breast carcinoma in patients with clinically negative axillary lymph nodes using radiotherapy versus axillary dissection. Cancer, 101: 2155–2163. doi: 10.1002/cncr.20650

Author Information

  1. 1

    Department of Surgery, Ofuna Chuo Hospital, Kamakura, Japan

  2. 2

    Department of Radiology, School of Medicine, Keio University, Tokyo, Japan

  1. ‡

    Fax: (011) 81 467411654

*Department of Surgery, Ofuna Chuo Hospital, 6-2-24, Kamakura, Kanagawa, 247-0056 Japan

  1. †

    Presented in part at the 38th annual meeting of the American Society of Clinical Oncology, Orlando, FL, May 18–21, 2002.

  2. ‡

    Fax: (011) 81 467411654

Publication History

  1. Issue published online: 29 OCT 2004
  2. Article first published online: 8 OCT 2004
  3. Manuscript Revised: 3 AUG 2004
  4. Manuscript Accepted: 3 AUG 2004
  5. Manuscript Received: 1 MAR 2004

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (101K)

REFERENCES

  • 1
    Fisher B, Redmond C, Fisher ER, et al. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med. 1984; 312: 674–681.
  • 2
    Cady B. Is axillary lymph node dissection necessary in routine management of breast cancer? No. Important Adv Oncol. 1996: 251–265.
  • 3
    Chadha M, Axelrod D. Is axillary node dissection always indicated in invasive breast cancer? Oncology (Huntington). 1997; 11: 1463–1468; discussion, 1468, 1473–1479.
  • 4
    Brenin DR, Morrow M, Moughan J, Owen JB, Wilson JF, Winchester DP. Management of axillary lymph nodes in breast cancer: a national patterns of care study of 17,151 patients. Ann Surg. 1999; 230: 686–691.
  • 5
    Durand JC, Poljicak M, Lefranc JP, Pilleron JP. Wide excision of the tumor and postoperative radiotherapy as treatment of small breast cancers. Cancer. 1984; 53: 2439–2443.
    Direct Link:
  • 6
    Read PE, Ash DV, Thorogood J, Benson EA. Short term morbidity and cosmesis following lumpectomy and radical radiotherapy for operable breast cancer. Clin Radiol. 1987; 38: 371–373.
  • 7
    Larson D, Weinstein M, Goldberg I, et al. Edema of the arm as a function of the extent of axillary surgery in patients with Stage I–II carcinoma of the breast treated with primary radiotherapy. Int J Radiat Oncol Biol Phys. 1986; 12: 1575–1582.
  • 8
    Siddon RL, Buck BA, Harris JR, Svensson GK. Three-field technique for breast irradiation using tangential field corner blocks. Int J Radiat Oncol Biol Phys. 1983; 9: 583–588.
  • 9
    Bloom HJ. Histological grading and prognosis in breast cancer: a study of 1409 cases of which 259 have been followed for 15 years. Br J Cancer. 1957; 11: 359–377.
  • 10
    Cox DR. Regression models and life-tables. J R Stat Soc B. 1972; 4: 187–220.
  • 11
    Baxter N, McCready D, Chapman JA, et al. Clinical behavior of untreated axillary nodes after local treatment for primary breast cancer. Ann Surg Oncol. 1996; 3: 235–240.
  • 12
    Wong JS, Recht A, Beard CJ, et al. Treatment outcome after tangential radiation therapy without axillary dissection in patients with early-stage breast cancer and clinically negative axillary nodes. Int J Radiat Oncol Biol Phys. 1997; 39: 915–920.
  • 13
    Ogawa Y, Nishioka A, Inomata T, et al. Conservation treatment intensified with tamoxifen and CAF chemotherapy without axillary dissection for early breast cancer patients with clinically-negative axillary nodes. Oncol Rep. 1999; 6: 801–805.
  • 14
    Greco M, Agresti R, Raselli R, Giovanazzi R, Veronesi U. Axillary dissection can be avoided in selected breast cancer patients: analysis of 401 cases. Anticancer Res. 1996; 16: 3913–3917.
  • 15
    Recht A, Pierce SM, Abner A, et al. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1991; 9: 988–996.
  • 16
    Kuznetsova M, Graybill JC, Zusag TW, Hartsell WF, Griem KL. Omission of axillary lymph node dissection in early-stage breast cancer: effect on treatment outcome. Radiology. 1995; 197: 507–510.
  • 17
    Wazer DE, Erban JK, Robert NJ, et al. Breast conservation in elderly women for clinically negative axillary lymph nodes without axillary dissection. Cancer. 1994; 74: 878–883.
    Direct Link:
  • 18
    Cabanes PA, Salmon RJ, Asselain B, et al. Value of axillary dissection in addition to lumpectomy and radiotherapy in early breast cancer. Lancet. 1992; 339: 1245–1248.
  • 19
    Louis-Sylvestre C, Clough K, Fourquet A, et al. Axillary treatment in conservative management of operable breast cancer: dissection of radiotherapy? Results of a randomized study with 15 years of follow-up. J Clin Oncol. 2004; 22: 97–101.
  • 20
    Goldhirsch A, Glick JH, Gelber RD, Coates AS, Senn HJ. Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. Seventh International Conference on Adjuvant Therapy of Primary Breast Cancer. J Clin Oncol. 2001; 19: 3817–3827.
  • 21
    Halverson KJ, Taylor ME, Perez CA, et al. Regional nodal management and patterns of failure following conservative surgery and radiation therapy for Stage 1 and 2 breast cancer. Int J Radiat Oncol Biol Phys. 1993; 26: 593–599.
  • 22
    Hoskin PJ, Rajan B, Ebbs S, Tait D, Milan S, Yarnold JR. Selective avoidance of lymphatic radiotherapy in the conservative management of early breast cancer. Radiother Oncol. 1992; 25: 83–88.
  • 23
    Inomata T, Takahashi M, Kariya S, et al. The relationship between the upper border of the tangential radiation portal for breast conserving therapy and the irradiation level of axillary lymph nodes [abstract]. Int J Radiat Oncol Biol Phys. 2002; 54(Suppl 2): 231.
  • 24
    Aristei C, Chionne F, Marsella AR, et al. Evaluation of Level I and II axillary nodes included in the standard breast tangential fields and calculation of the administered dose: results of a prospective study. Int J Radiat Oncol Biol Phys. 2001; 51: 69–73.
  • 25
    Bentel GC, Markd LB, Hardenbergh PH, Prosnitz LR. Variability of the depth of supraclavicular and axillary lymph nodes in patients with breast cancer: is a posterior axillary boost field necessary? Int J Radiat Oncol Biol Phys. 2000; 47: 755–758.
  • 26
    Goodman RL, Grann A, Saracco P, Needham MF. The relationship between radiation fields and regional lymph nodes in carcinoma of the breast. Int J Radiat Oncol Biol Phys. 2001; 50: 99–105.
  • 27
    Krasin M, McCall A, King S, Olson M, Emami B. Evaluation of a standard breast tangent technique: a dose-volume analysis of tangential irradiation using three-dimensional tools. Int J Radiat Oncol Biol Phys. 2000; 47: 327–333.
  • 28
    Reznik J, Cicchetti MG, FitzGerald TJ, et al. Analysis of axillary coverage during tangential radiation therapy to the breast. Int J Radiat Oncol Biol Phys. 2001; 51(Suppl 1): 1–7.
  • 29
    Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985; 312: 665–673.
  • 30
    Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002; 347: 1233–1241.
  • 31
    Chung MA, DiPetrillo T, Hernandez S, Masko G, Wazer D, Cady B. Treatment of the axilla by tangential breast radiotherapy in women with invasive breast cancer. Am J Surg. 2002; 184: 401–402.
  • 32
    Hoebers FJ, Borger JH, Hart AA, Peterse JL, Rutgers EJ, Lebesque JV. Primary axillary radiotherapy as axillary treatment in breast-conserving therapy for patients with breast carcinoma and clinically negative axillary lymph nodes. Cancer. 2000; 88: 1633–1642.
    Direct Link:
  • 33
    Zurrida S, Orecchia R, Veronesi U, et al. Axillary radiotherapy instead of axillary dissection: a randomized trial. Ann Surg Oncol. 2002; 9: 156–160.
  • 34
    Greco C, Orecchia R, Valesi G, et al. Randomized clinical trial on the role of axillary radiotherapy in breast conservative management without axillary dissection for lesions < 1 cm [abstract]. Int J Radiat Oncol Biol Phys. 1998; 42(Suppl 1): 350.
  • 35
    Gatti GM, Casanova L, Orecchia R, et al. Study on the role of quadrantectomy alone [abstract]. Radiother Oncol. 1998; 48(Suppl 1): S119.
  • 36
    Thomas R, Taddeo F, Rinaldo M, et al. Superconservative surgery for early breast cancer: preliminary results [abstract]. Eur J Cancer. 1998; 34(Suppl 5): S49–S50.
  • 37
    Takeda A, Shigematsu N, Kondo M, et al. The modified tangential irradiation technique for breast cancer: how to cover the entire axillary region. Int J Radiat Oncol Biol Phys. 2000; 46: 815–822.
  • 38
    Maibenco DC, Weiss LK, Pawlish KS, Severson RK. Axillary lymph node metastases associated with small invasive breast carcinomas. Cancer. 1999; 85: 1530–1536.
    Direct Link:
  • 39
    Galper S, Recht A, Silver B, et al. Factors associated with regional nodal failure in patients with early stage breast cancer with 0–3 positive axillary nodes following tangential irradiation alone. Int J Radiat Oncol Biol Phys. 1999; 45: 1157–1166.
  • 40
    Cady B. Use of primary breast carcinoma characteristics to predict lymph node metastases. Cancer. 1997; 79: 1856–1861; discussion, 1862–1864.
    Direct Link:
  • 41
    Martin C, Cutuli B, Velten M. Predictive model of axillary lymph node involvement in women with small invasive breast carcinoma: axillary metastases in breast carcinoma. Cancer. 2002; 94: 314–322.
    Direct Link:
  • 42
    Olivotto IA, Jackson JS, Mates D, et al. Prediction of axillary lymph node involvement of women with invasive breast carcinoma: a multivariate analysis. Cancer. 1998; 83: 948–955.
    Direct Link:
  • 43
    Ravdin PM, De Laurentiis M, Vendely T, Clark GM. Prediction of axillary lymph node status in breast cancer patients by use of prognostic indicators. J Natl Cancer Inst. 1994; 86: 1771–1775.
  • 44
    Renolleau C, Merviel P, Clough KB, Asselain B, Campana F, Durand JC. Isolated axillary recurrences after conservative treatment of breast cancer. Eur J Cancer. 1996; 32A: 617–621.
  • 45
    Silverstein MJ, Skinner KA, Lomis TJ. Predicting axillary nodal positivity in 2282 patients with breast carcinoma. World J Surg. 2001; 25: 767–772.
  • 46
    Fein DA, Fowble BL, Hanlon AL, et al. Identification of women with T1–T2 breast cancer at low risk of positive axillary nodes. J Surg Oncol. 1997; 65: 34–39.
    Direct Link:
  • 47
    Gann PH, Colilla SA, Gapstur SM, Winchester DJ, Winchester DP. Factors associated with axillary lymph node metastasis from breast carcinoma: descriptive and predictive analyses. Cancer. 1999; 86: 1511–1519.
    Direct Link:
  • 48
    Chadha M, Chabon AB, Friedmann P, Vikram B. Predictors of axillary lymph node metastases in patients with T1 breast cancer: a multivariate analysis. Cancer. 1994; 73: 350–353.
    Direct Link:
  • 49
    Wong JS, O'Neill A, Recht A, et al. The relationship between lymphatic vessel invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection? Int J Radiat Oncol Biol Phys. 2000; 48: 133–137.
View Full Article (HTML) Get PDF (101K)