Radiotherapy of the lymphatic drainage pathways in breast carcinoma: time for a reassessment

Autor:	Wilfried Budach, Marie-Luise Sautter-Bihl, Rolf Sauer, Felix Sedlmayer, F. Wenz, Rainer Souchon, Jürgen Dunst, René Baumann, P. Feyer, Wulf Haase, David Krug, Marc D Piroth, Rainer Fietkau, Wolfgang Harms
Rok vydání:	2017
Předmět:	medicine.medical_specialty business.industry medicine.medical_treatment Sentinel node medicine.disease Surgery Radiation therapy Axilla medicine.anatomical_structure Lymphatic system Breast cancer medicine Immunogenic cell death Radiology Breast carcinoma business Cohort study
Zdroj:	Senologie - Zeitschrift für Mammadiagnostik und -therapie. 14:92-98
ISSN:	1611-647X 1611-6453
Popis:	Background The treatment administered for regional lymph nodes has altered dramatically in recent years. The state of the evidence on radiotherapy has also substantially improved and a reassessment is required. Materials and results Randomized studies are available on axillary surgery versus radiotherapy (AMAROS); on refraining from axillary dissection after a positive sentinel node (SN) when radiotherapy is planned (ACOSOG Z0011); and on adjuvant radiotherapy of the regional lymph nodes (LNs). ACOSOG Z0011 shows that refraining from axillary dissection is possible even when there are one or two positive SNs. The meta-analysis of the studies on adjuvant radiotherapy for the regional LNs (EORTC, Canadian, and French studies) shows a significant survival benefit with radiotherapy, and a Danish cohort study has confirmed this result. The reduction in breast cancer–specific mortality in these studies was partly based on a “systemic” effect of regional radiotherapy, with a reduction in the rate of distant metastases. Conclusions The principle applying in surgical treatment of the axilla is “less is not worse.” By contrast, the principle applying in radiotherapy of the regional lymph nodes is “more may be better in some circumstances.” There is as yet no clear explanation for the discrepancy between these two findings. An immunological effect (through immunogenic cell death due to irradiation) has been discussed. Further research is needed on which patients are today capable of benefiting from regional radiotherapy.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::bb63d76397af741ea04c33ca74f83da6 https://doi.org/10.1055/s-0043-105471 Zobrazit plný text záznamu