Locoregional treatment of early breast cancer with isolated tumor cells or micrometastases on sentinel lymph node biopsy

doi:10.5306/wjco.v7.i2.243

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World Journal of Clinical Oncology

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World J Clin Oncol. Apr 10, 2016; 7(2): 243-252
Published online Apr 10, 2016. doi: 10.5306/wjco.v7.i2.243

Locoregional treatment of early breast cancer with isolated tumor cells or micrometastases on sentinel lymph node biopsy

Agnès Tallet, Eric Lambaudie, Monique Cohen, Mathieu Minsat, Marie Bannier, Michel Resbeut, Gilles Houvenaeghel

Agnès Tallet, Mathieu Minsat, Michel Resbeut, Departement of Radiotherapy, Institut Paoli Calmettes and CRCM, 13009 Marseille, France

Eric Lambaudie, Monique Cohen, Marie Bannier, Gilles Houvenaeghel, Departement of Surgery, Institut Paoli Calmettes and CRCM, 13009 Marseille, France

Eric Lambaudie, Gilles Houvenaeghel, Aix Marseille Université, Jardin du Pharo, 13284 Marseille, France

Author contributions: Tallet A, Lambaudie E and Houvenaeghel G performed the majority of the writing and prepared tables; others have contributed to the writing of manuscript.

Conflict-of-interest statement: There is no conflict of interest associated with any of senior author, coauthors, contributed their efforts in this manuscript.

Correspondence to: Gilles Houvenaeghel, MD, Departement of Surgery, Institut Paoli Calmettes and CRCM, 232 Bd de Sainte Marguerite, 13009 Marseille, France. houvenaeghelg@ipc.unicancer.fr

Telephone: +33-04-91223532 Fax: +33-04-91223613

Received: June 19, 2015
Peer-review started: June 27, 2015
First decision: July 31, 2015
Revised: February 25, 2016
Accepted: March 9, 2016
Article in press: March 14, 2016
Published online: April 10, 2016
Processing time: 292 Days and 16.3 Hours

Abstract

The advent of sentinel lymph-node technique has led to a shift in lymph-node staging, due to the emergence of new entities namely micrometastases (pN1mi) and isolated tumor cells [pN0(i+)]. The prognostic significance of this low positivity in axillary lymph nodes is currently debated, as is, therefore its management. This article provides updates evidence-based medicine data to take into account for treatment decision-making in this setting, discussing the locoregional treatment in pN0(i+) and pN1mi patients (completion axillary dissection, axillary irradiation with or without regional nodes irradiation, or observation), according to systemic treatment, with the goal to help physicians in their daily practice.

Keywords: Breast cancer; Micrometastases; Axillary lymph node dissection; Radiotherapy; Isolated tumor cells

Core tip: Sentinel lymph-node biopsy has led to a shift in lymph-node staging, due to the emergence of new entities namely micro-metastases and isolated tumor cells. The prognostic significance of this low positivity in axillary lymph nodes is currently debated, as is, therefore its management. This review provides updates evidence-based medicine data to take into account for treatment decision-making in this setting, discussing several loco-regional therapeutic strategies based on recent clinical trials results, particularly completion axillary dissection, axillary irradiation, regional nodes irradiation, with according to systemic treatment, with the goal to help physicians in daily practice.