Is axillary lymph node clearance required in node-positive breast cancer?
Identifieur interne : 001C34 ( Main/Exploration ); précédent : 001C33; suivant : 001C35Is axillary lymph node clearance required in node-positive breast cancer?
Auteurs : Nigel J. Bundred [Royaume-Uni] ; Nicola L P. Barnes [Royaume-Uni] ; Emiel Rutgers [Pays-Bas] ; Mila Donker [Pays-Bas]Source :
- Nature reviews. Clinical oncology [ 1759-4782 ] ; 2015.
Descripteurs français
- KwdFr :
- Aisselle (), Aisselle (anatomopathologie), Biopsie de noeud lymphatique sentinelle, Femelle, Humains, Lymphadénectomie, Micrométastase tumorale (anatomopathologie), Métastase lymphatique (anatomopathologie), Métastase lymphatique (diagnostic), Métastase lymphatique (radiothérapie), Noeuds lymphatiques (), Noeuds lymphatiques (anatomopathologie), Récidive tumorale locale (), Récidive tumorale locale (anatomopathologie), Récidive tumorale locale (radiothérapie), Résultat thérapeutique, Tumeurs du sein (anatomopathologie).
- MESH :
- anatomopathologie : Aisselle, Micrométastase tumorale, Métastase lymphatique, Noeuds lymphatiques, Récidive tumorale locale, Tumeurs du sein.
- diagnostic : Métastase lymphatique.
- radiothérapie : Métastase lymphatique, Récidive tumorale locale.
- Aisselle, Biopsie de noeud lymphatique sentinelle, Femelle, Humains, Lymphadénectomie, Noeuds lymphatiques, Récidive tumorale locale, Résultat thérapeutique.
English descriptors
- KwdEn :
- Axilla (pathology), Axilla (surgery), Breast Neoplasms (pathology), Female, Humans, Lymph Node Excision, Lymph Nodes (pathology), Lymph Nodes (surgery), Lymphatic Metastasis (diagnosis), Lymphatic Metastasis (pathology), Lymphatic Metastasis (radiotherapy), Neoplasm Micrometastasis (pathology), Neoplasm Recurrence, Local (pathology), Neoplasm Recurrence, Local (radiotherapy), Neoplasm Recurrence, Local (surgery), Sentinel Lymph Node Biopsy, Treatment Outcome.
- MESH :
- diagnosis : Lymphatic Metastasis.
- pathology : Axilla, Breast Neoplasms, Lymph Nodes, Lymphatic Metastasis, Neoplasm Micrometastasis, Neoplasm Recurrence, Local.
- radiotherapy : Lymphatic Metastasis, Neoplasm Recurrence, Local.
- surgery : Axilla, Lymph Nodes, Neoplasm Recurrence, Local.
- Female, Humans, Lymph Node Excision, Sentinel Lymph Node Biopsy, Treatment Outcome.
Abstract
Although the majority of patients with breast cancer have clinically negative axillary nodes at preoperative assessment, around 15-20% of these women will have metastatic disease within the lymph nodes at operative sentinel node biopsy, and additional selective treatment to the axilla might be required. Local treatment to the axilla can include axillary node clearance or axillary radiotherapy. The recent results of the American College of Surgeons Oncology Group Z0011 trial suggested that some women would be safe from recurrence without further axillary treatment if they have less than three involved sentinel nodes, with no extracapsular spread. We review the evidence base for management of the axilla after detection of a positive sentinel node, discuss the evidence for why micrometastatic disease requires systemic but not axillary therapy, and present data suggesting that axillary irradiation for macrometastases gives equivalent control to axillary node clearance, but causes less morbidity such as lymphoedema. Ongoing trials will confirm whether any further therapy can be omitted for all patients with low volume, sentinel-node macrometastases.
DOI: 10.1038/nrclinonc.2014.188
PubMed: 25367714
Affiliations:
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Bundred</name><affiliation wicri:level="1"><nlm:affiliation>Department of Academic Surgery, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Academic Surgery, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT</wicri:regionArea><wicri:noRegion>Manchester M23 9LT</wicri:noRegion></affiliation></author><author><name sortKey="Barnes, Nicola L P" sort="Barnes, Nicola L P" uniqKey="Barnes N" first="Nicola L P" last="Barnes">Nicola L P. Barnes</name><affiliation wicri:level="1"><nlm:affiliation>Department of Academic Surgery, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Academic Surgery, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT</wicri:regionArea><wicri:noRegion>Manchester M23 9LT</wicri:noRegion></affiliation></author><author><name sortKey="Rutgers, Emiel" sort="Rutgers, Emiel" uniqKey="Rutgers E" first="Emiel" last="Rutgers">Emiel Rutgers</name><affiliation wicri:level="3"><nlm:affiliation>Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 100CX, Amsterdam, Netherlands.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 100CX, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Donker, Mila" sort="Donker, Mila" uniqKey="Donker M" first="Mila" last="Donker">Mila Donker</name><affiliation wicri:level="3"><nlm:affiliation>Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 100CX, Amsterdam, Netherlands.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 100CX, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author></analytic><series><title level="j">Nature reviews. Clinical oncology</title><idno type="eISSN">1759-4782</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Axilla (pathology)</term><term>Axilla (surgery)</term><term>Breast Neoplasms (pathology)</term><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Lymph Nodes (pathology)</term><term>Lymph Nodes (surgery)</term><term>Lymphatic Metastasis (diagnosis)</term><term>Lymphatic Metastasis (pathology)</term><term>Lymphatic Metastasis (radiotherapy)</term><term>Neoplasm Micrometastasis (pathology)</term><term>Neoplasm Recurrence, Local (pathology)</term><term>Neoplasm Recurrence, Local (radiotherapy)</term><term>Neoplasm Recurrence, Local (surgery)</term><term>Sentinel Lymph Node Biopsy</term><term>Treatment Outcome</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Aisselle ()</term><term>Aisselle (anatomopathologie)</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Femelle</term><term>Humains</term><term>Lymphadénectomie</term><term>Micrométastase tumorale (anatomopathologie)</term><term>Métastase lymphatique (anatomopathologie)</term><term>Métastase lymphatique (diagnostic)</term><term>Métastase lymphatique (radiothérapie)</term><term>Noeuds lymphatiques ()</term><term>Noeuds lymphatiques (anatomopathologie)</term><term>Récidive tumorale locale ()</term><term>Récidive tumorale locale (anatomopathologie)</term><term>Récidive tumorale locale (radiothérapie)</term><term>Résultat thérapeutique</term><term>Tumeurs du sein (anatomopathologie)</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Aisselle</term><term>Micrométastase tumorale</term><term>Métastase lymphatique</term><term>Noeuds lymphatiques</term><term>Récidive tumorale locale</term><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Lymphatic Metastasis</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Métastase lymphatique</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Axilla</term><term>Breast Neoplasms</term><term>Lymph Nodes</term><term>Lymphatic Metastasis</term><term>Neoplasm Micrometastasis</term><term>Neoplasm Recurrence, Local</term></keywords><keywords scheme="MESH" qualifier="radiotherapy" xml:lang="en"><term>Lymphatic Metastasis</term><term>Neoplasm Recurrence, Local</term></keywords><keywords scheme="MESH" qualifier="radiothérapie" xml:lang="fr"><term>Métastase lymphatique</term><term>Récidive tumorale locale</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Axilla</term><term>Lymph Nodes</term><term>Neoplasm Recurrence, Local</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Sentinel Lymph Node Biopsy</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Aisselle</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Femelle</term><term>Humains</term><term>Lymphadénectomie</term><term>Noeuds lymphatiques</term><term>Récidive tumorale locale</term><term>Résultat thérapeutique</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Although the majority of patients with breast cancer have clinically negative axillary nodes at preoperative assessment, around 15-20% of these women will have metastatic disease within the lymph nodes at operative sentinel node biopsy, and additional selective treatment to the axilla might be required. Local treatment to the axilla can include axillary node clearance or axillary radiotherapy. The recent results of the American College of Surgeons Oncology Group Z0011 trial suggested that some women would be safe from recurrence without further axillary treatment if they have less than three involved sentinel nodes, with no extracapsular spread. We review the evidence base for management of the axilla after detection of a positive sentinel node, discuss the evidence for why micrometastatic disease requires systemic but not axillary therapy, and present data suggesting that axillary irradiation for macrometastases gives equivalent control to axillary node clearance, but causes less morbidity such as lymphoedema. Ongoing trials will confirm whether any further therapy can be omitted for all patients with low volume, sentinel-node macrometastases.</div></front></TEI><affiliations><list><country><li>Pays-Bas</li><li>Royaume-Uni</li></country><region><li>Hollande-Septentrionale</li></region><settlement><li>Amsterdam</li></settlement></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Bundred, Nigel J" sort="Bundred, Nigel J" uniqKey="Bundred N" first="Nigel J" last="Bundred">Nigel J. Bundred</name></noRegion><name sortKey="Barnes, Nicola L P" sort="Barnes, Nicola L P" uniqKey="Barnes N" first="Nicola L P" last="Barnes">Nicola L P. Barnes</name></country><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Rutgers, Emiel" sort="Rutgers, Emiel" uniqKey="Rutgers E" first="Emiel" last="Rutgers">Emiel Rutgers</name></region><name sortKey="Donker, Mila" sort="Donker, Mila" uniqKey="Donker M" first="Mila" last="Donker">Mila Donker</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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