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PubMed1997

Segmental mastectomy and tamoxifen alone provide adequate locoregional control of breast cancer in elderly women.

We wished to determine whether tamoxifen and local excision without breast radiation or axillary lymph node dissection provides adequate local and regional control of breast cancer in elderly women. The records of 36 women with breast cancer who were more than 70 years old and were treated only with tamoxifen and local excision from January 1985 to July 1996 were retrospectively reviewed. These patients had refused, or were considered too ill for, standard therapy. The mean follow-up was 44.1 months. Twenty-two (61%) were alive without disease, and six (17%) died of unrelated causes, without recurrence. Two (6%) were alive with metastasis, and five (14%) died with metastasis. One patient developed a breast recurrence, which was reexcised. A second patient developed metastasis and axillary recurrence, which was treated with modified radical mastectomy. Pathologic grade, tumor size, and estrogen receptor and margin status were not predictive of recurrence. In conclusion, despite the omission of breast radiation and axillary dissection, there were only two locoregional recurrences, and both were easily treated surgically. In this select group of patients, local excision and tamoxifen provided adequate locoregional control of breast cancer in elderly women.

Aged↗

PubMedDate not supplied

Influence of the timing of physiotherapy upon the lymphatic complications of axillary dissection for breast cancer.

A prospective randomized study was carried out to discover the influence of the timing of shoulder physiotherapy after-axillary dissection for breast cancer upon the incidence and duration of lymphatic fluid production and seroma after these operations. Sixty-eight patients underwent a modified radical mastectomy, 31 were submitted to early physiotherapy and 37 to delayed physiotherapy after removal of the suction drainage. In 32 patients this surgery was conservative of the breast; in 16 the physiotherapy was early and in 16 delayed. The shoulder was left free when the physiotherapy was delayed. The mean volume of lymphatic fluid produced after these 100 axillary dissections was 437 cc (range: 50 to 800 cc) with a mean duration of 6.3 days (range: 2 to 11 days). There was a linear relation between the volume and the duration of the lymphatic fluid production. This volume was significantly higher in radical mastectomy than in conservative procedures (486 cc vs 333 cc - p less than 0.02). There was no significant difference in the production of lymphatic fluid with early or delayed physiotherapy, whatever the group of patients: radical or conservative surgery - age - number of excised lymph nodes - lymph node involvement. Five seromas occurred in patients with delayed physiotherapy. Delaying physiotherapy after axillary dissection for breast cancer does not seem to reduce the incidence of lymphatic complication, but the use of a conservative procedure rather than a modified radical mastectomy seems to be able to do so.

Adult↗

PubMed2005

Clinical investigation: regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy.

PURPOSE: The purpose of this study was to describe regional nodal failure patterns in patients who had undergone mastectomy with axillary dissection to define subgroups of patients who might benefit from supplemental regional nodal radiation to the axilla or supraclavicular fossa/axillary apex. METHODS AND MATERIALS: The cohort consisted of 1031 patients treated with mastectomy (including a level I-II axillary dissection) and doxorubicin-based systemic therapy without radiation on five clinical trials at M.D. Anderson Cancer Center. Patient records, including pathology reports, were retrospectively reviewed. All regional recurrences (with or without distant metastasis) were recorded. Median follow-up was 116 months (range, 6-262 months). RESULTS: Twenty-one patients recurred within the low-mid axilla (10-year actuarial rate 3%). Of these, 16 were isolated regional failures (no chest wall failure). The risk of failure in the low-mid axilla was not significantly higher for patients with increasing numbers of involved nodes, increasing percentage of involved nodes, larger nodal size or gross extranodal extension. Only 3 of 100 patients with <10 nodes examined recurred in the low-mid axilla. Seventy-seven patients had a recurrence in the supraclavicular fossa/axillary apex (10-year actuarial rate 8%). Forty-nine were isolated regional recurrences. Significant predictors of failures in this region included > or = 4 involved axillary lymph nodes, >20% involved axillary nodes, and the presence of gross extranodal extension (10-year actuarial rates 15%, 14%, and 19%, respectively, p < 0.0005). The extent of axillary dissection and the size of the largest involved node were not predictive of failure within the supraclavicular fossa/axillary apex. CONCLUSIONS: These results suggest that failure in the level I-II axilla is an uncommon occurrence after modified radical mastectomy and chemotherapy. Therefore, supplemental radiotherapy to the dissected axilla is not warranted for most patients. However, patients with > or = 4 involved axillary lymph nodes, >20% involved axillary nodes, or gross extranodal extension are at increased risk of failure in the supraclavicular fossa/axillary apex and should receive radiation to undissected regions in addition to the chest wall.

Adult↗

PubMed1984

[Surgical therapy of breast cancer: to operate radically or to preserve the breast?].

Surgical treatment, i.e. partial resection (R) versus modified radical mastectomy (M) in lymph node negative T1/2 patients and M versus the classical Halsted procedure (RM) in lymph node positive cases, as well as adjuvant treatment forms, namely chemotherapy (B) and chemoimmunotherapy (C) versus a control group treated by surgery only (A) have been evaluated in 241 patients with breast cancer follow up over a median observation time of 48 months. Whereas M showed significantly better results than R, no difference was detected between M and RM. The incidence of recurrence in the R group did not appear to be markedly reduced by cytotoxic treatment. In the same way, the data from a retrospective study on non-randomized patients treated by breast resection, showed a relatively high local recurrence rate (23.6%) at a median observation level of 10 years. Considering the various forms of surgical treatment for operable breast cancer by analysing the data from retrospective studies and prospective randomized trials from the literature as well as our own results, the only recommendation for the standard treatment of patients with primary operable breast cancer should be nothing less than modified radical mastectomy. Breast-conserving treatment forms should be tested only within the framework of controlled clinical trials.

Breast Neoplasms↗

PubMed1996

Skin-sparing mastectomy with immediate breast reconstruction: the M. D. Anderson Cancer Center experience.

BACKGROUND: Skin-sparing mastectomy with immediate reconstruction has become popular with patients because, compared with delayed reconstruction, it improves the cosmetic result, reduces cost and anesthetic risk, and in one stage completes most of the surgical treatment that the patient will ever require for treatment of her breast cancer. In the past, reconstruction was often delayed because of an unwarranted fear of locoregional recurrence or because the patient, having to live for some time with a flat chest wall, would be more appreciative of her reconstruction. This concept is now considered unacceptable, and many women regard this attitude as evidence of a lack of concern for the psychological impact of mastectomy. METHOD: Provided that the breast skin is not involved with or close to the tumor, we prefer to perform the mastectomy with removal of only the nipple-areolar complex and the tumor biopsy scar. The mastectomy is otherwise the same as a standard modified radical mastectomy with removal of all breast tissue and a level I-II axillary node dissection. Our preference is to use the transverse rectus abdominis myocutaneous flap with a microvascular anastomosis because it provides a better blood supply, reduces abdominal wall muscle sacrifice, and eliminates the bulge from tunneling required by a pedicled flap. RESULT: Using the skin-sparing technique with immediate reconstruction in 545 patients with early-stage breast cancer, our overall incidence of regional recurrence was 2.6%. Of 95 patients who were followed for > four years, the recurrence rate was 4.2%. CONCLUSIONS: Regional recurrence after skin-sparing mastectomy is a function of the biology of the tumor and the stage of the disease and is not affected by the use of immediate reconstruction or skin-preservation mastectomy.

Female↗

PubMedDate not supplied

Determinants of wound infections after surgery for breast cancer.

BACKGROUND: There are evident risks factors stemming from any the local post-surgical infection, which merits analysis of morbidity derived from conservative and radical surgery after treatment of the operable breast cancer. STUDY DESIGN: 107 patients with breast cancer recruited between November 1995 and October 1997 were evaluated. From that total, 36 patients were subjected to quadrantectomy, axillary lymphadenectomy and postoperative radiation while 71 patients were subjected to modified radical mastectomy. RESULTS: 7 % percent of patients who underwent modified radical surgery succumbed to postoperative local infection vs. 17 % of patients subjected to breast conserving therapies. Local infections were associated with the older patients (63 vs. 54 years old, p=0.03) and greater obesity (p=0.04). Upon logistic regression analysis conservative surgery exhibited adjusted Odds Ratio of 6.42 (1.27-32.28), p =0.02. In postoperative infection group average hospital stay increased by 6 days (p= 0.0001). CONCLUSION: In the present study main risk factors associated with postsurgical wound infection after breast cancer treatment proved to be advanced age, greater obesity and conservative surgery. Nonetheless, more studies are necessary to confirm current findings.

Breast Neoplasms↗

PubMedDate not supplied

p53 and Ki-67 expression as prognostic factors in cystosarcoma phyllodes.

We have reviewed the histopathological, clinical outcome and immunohistochemical status in 21 women with cystosarcoma phyllodes (CSP) tumors of the breast. We assessed 12 tumors as histopathologically benign and 9 tumors as malignant. The median patient ages in benign and malignant CSP tumors were 39.6 and 45.4 years of age, respectively. The stromal cellularity, stromal cellular atypism, high mitotic activity, atypic mitoses, stromal overgrowth, infiltrative tumor contour, and heterologous stromal elements were significant features of the malignant CSP tumors. Benign CSP tumors were predominantly of fibroadenomatous architecture with cellular stroma (mild or moderate) and some distortion and elongation of glandular elements. Five malignant CSP tumors were stained positively with p53, and 6 malignant CSP tumors were stained immunohistochemically with Ki-67. All benign CSP tumors were negatively stained for p53 and Ki-67. The patients with benign CSP tumors were treated with local excision ( n=11) and with subcutaneous mastectomy ( n=1). Malignant CSP tumors were treated with wide local excision ( n=1), partial mastectomy ( n=1), simple mastectomy ( n=2), and modified radical mastectomy ( n=5). Two patients with a high mitotic rate and high values of p53 and Ki-67 received additional radiotherapy and chemotherapy. One case had liver metastasis. This tumor had high mitotic figures, stromal overgrowth, severe stromal cellularity, and 20% Ki-67 and mild p53 positivity. We suggest that p53 and Ki-67 can play an important role in predicting prognosis and yielding additional therapy besides conventional prognostic factors in the treatment of the CSP patients.

Adolescent↗

PubMed1995

[Mammary phyllodes tumor. A clinico-pathological review of 14 cases].

We report a retrospective analysis of 14 female patients, aged 20 to 62 years old, with phyllodes tumors of the breast. The tumors were located in the right breast in nine patients and their diameter ranged from 2.5 to 28 cm. Six mammographies and six needle cytological examinations were performed and aided very little to the diagnosis. The preoperative diagnosis was correct in five patients and the principal differential diagnosis was fibroadenoma. Eight patients were subjected to tumorectomy, three to simple mastectomy, one to a cleaning mastectomy, one to a modified radical mastectomy and one to a subcutaneous mastectomy. The anatomopathologic study disclosed an increased stromal growth in two patients and increased stromal cellularity in six cases. Only one case had more than five mitoses per microscopic field. Phyllodes tumors are infrequent, their diagnosis requires a high degree of clinical suspicion and they have a benign biologic behaviour.

Adult↗

PubMedDate not supplied

[Occult breast cancer].

In 20 years we registered seven observations of breast cancer presenting as an axillary mass (BCAM), meaning 0.9% out of the global breast cancer series (767 cases). All the cases were females. The main clinical sign was only the presence of axillary lymph nodes. Diagnosis was precised by the pathological examination of the excised nodes (six observations) or needle aspiration of the axillary lymph nodes. Mammography showed tumors less than one centimeter in three out of the seven cases. As for the stadialisation, we had two cases in the II-nd stage, four patients in the III-rd stage and one in IV-th. All the patients were operated on. There were four simple mastectomies anti three Patey radical modified mastectomies. Postoperative chemotherapy and radiotherapy were performed to all the patients. Only two of the seven patients survived five years after surgery.

Aged↗

PubMed2003

Preoperative emotional states in patients with breast cancer and postoperative pain.

BACKGROUND: The present study examined the relationship between psychological variables, including anxiety, depression, and patient-controlled analgesia (PCA) use in patients who underwent radical mastectomy. METHODS: Ninety-nine ASA I-II women with breast cancer between 18 and 60 years scheduled for modified radical mastectomy completed the state scale of the state-trait anxiety inventory and the Beck depression inventory before the day of surgery. Standard general anesthesia, surgery, and IV-PCA therapy was conducted. Postoperative ratings of pain intensity, opioid consumption and satisfaction with PCA were recorded for the first 24 h on the ward. The degree of pain intensity was evaluated by a visual analog scale (VAS, 1-10). Satisfaction with pain control was reported using an five-point scale from 1 (very dissatisfied) to 5 (very satisfied). RESULTS: The pain intensity, total analgesic consumption and dose/demand ratio were significantly related to preoperative anxiety and depression (P<0.05). Degree of dissatisfaction with PCA was significantly correlated with preoperative anxiety and depression (P<0.01). CONCLUSION: Patients with higher anxiety and depression levels had higher postoperative pain and analgesic requirements in this study.

Adolescent↗

PubMed1997

[Lymphedema after breast carcinoma. A study of 5868 cases].

BASIC PROBLEM AND OBJECTIVE: According to published reports, the incidence of lymphoedema of the arm in patients with cancer of the breast, treated by either surgery or radiotherapy, varies widely. We obtained basic data on the treatment of breast cancer in a large number of patients in order to determine the relationship between the incidence of lymphoedema and the radical nature of the primary treatment. PATIENTS AND METHODS: Data were collected on all women with lymphoedema of the arm after treatment for breast cancer between 1972 and 1995. The increase in arm circumference was measured by a standardised method. Only those patients were included in the final analysis whose arm circumference had increased by at least 2 cm. The type of operation and(or) radiotherapy, tumor histology and TNM classification were recorded. RESULTS: There were 1405 cases of arm lymphoedema after treatment of 5868 cases of breast cancer (24%). 2515 breast cancers had been treated surgically. 3353 surgically and by radiotherapy. Lymphoedema occurred in 22.3% after radical mastectomy without radiotherapy and in 44.4% with it; after modified radical mastectomy without radiotherapy in 19.1%, in 28.9% with radiotherapy; after breast-preserving operation without radiotherapy in 6.7%, with radiotherapy in 10.1%. Until the 1970s radical mastectomy with conventional postoperative radiotherapy has been the treatment of choice, with 38% cases of lymphoedema. This incidence gradually decreased to 16% in subsequent years. CONCLUSION: The incidence of lymphoedema of the arm depends on the radical nature of the primary treatment. The quality of life could be easily improved through minimising the incidence of lymphoedema if current standards of breast-preserving surgery were generally practised.

Adult↗

PubMed1994

Recurrent breast cancer following immediate reconstruction with myocutaneous flaps.

As immediate breast reconstruction with rectus abdominis and latissimus dorsi myocutaneous flaps has become a recognized technique for patients requiring mastectomy, concerns have arisen regarding the detection and treatment of locoregional recurrence of breast cancer. Because most recurrences develop in the residual native skin of the chest wall following a mastectomy, breast reconstruction procedures involving the placement of a subpectoral prosthesis are unlikely to interfere with postoperative cancer surveillance. Myocutaneous flaps, however, transpose blocs of soft tissues into the mastectomy site. This study was done to evaluate the influence of a myocutaneous flap on the subsequent diagnosis and treatment of locoregional recurrence of breast cancer. Data were obtained from 161 patients with breast cancer who had immediate reconstruction with a myocutaneous flap between 1982 and 1990. Of the 161 patients reviewed, 120 had primary mastectomy with immediate reconstruction; 41 patients had salvage mastectomy and immediate reconstruction after failed conservative surgery and radiation therapy. Modified radical mastectomy was performed on all patients. Either a rectus abdominis (n = 65) or latissimus dorsi (n = 97) myocutaneous flap breast reconstruction was performed. Recurrent tumor was observed in 17 of the 161 patients reviewed (10.6 percent). Fourteen of the 17 recurrences occurred in 120 patients having primary mastectomy and immediate reconstruction for a rate of 11.7 percent; 3 of 41 patients (7.3 percent) who had salvage mastectomy and flap reconstruction developed recurrences. Of the 17 recurrences, 6 patients were stage II, 10 were stage III, and 1 was stage IV. All 17 patients who developed a recurrence had invasive breast cancer, with infiltrating and inflammatory tumors predominating. All locoregional recurrences of breast cancer developed within the native skin and subcutaneous tissues adjacent to the mastectomy and flap reconstruction site. Recurrences were seen as rapidly as 2 weeks or as long as 3.8 years (mean 1.4) after the mastectomy and flap reconstruction. Overall mean follow-up for the entire group of 161 patients was 5.4 years. Thirteen of the 17 patients (76.5 percent) developed distant metastases either concomitantly with the locoregional recurrence or within 4.3 years (mean 1.7). From an oncologic viewpoint, the technique of myocutaneous flap breast reconstruction with rectus abdominis or latissimus dorsi flaps appears to be a safe one. An analysis of locoregional recurrence of breast cancer in patients undergoing primary mastectomy or salvage mastectomy with myocutaneous flap breast reconstruction did not show concealment by the flap of any recurrent tumor.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenocarcinoma↗

PubMed1998

Long-term follow-up of axillary node-positive breast cancer patients receiving adjuvant tamoxifen alone: patterns of recurrence.

PURPOSE: To determine the patterns, incidence and risk factors for local-regional recurrence in patients with Stage II and III breast cancer treated with adjuvant tamoxifen alone, without adjuvant radiation. MATERIAL AND METHODS: The records of patients referred to the London Regional Cancer Centre with a diagnosis of breast cancer between 1980-1989 were reviewed. During this time period, it was the policy of the institution to omit local-regional radiation to patients receiving adjuvant systemic therapy. One hundred and fifty axillary node-positive Stage II and III breast cancer patients received adjuvant tamoxifen alone without postoperative local-regional radiation; these patients form the basis of this report. RESULTS: Median follow-up was 67 months for the entire patient group and 85 months for the living patients. During this time, 42% of patients developed a recurrence, 22% first recurred in local-regional sites. The total incidence of local-regional recurrence (including those patients who first relapsed with systemic metastases) was 30%. Of the segmental mastectomy patients, 13% had recurrences in the intact breast. Of the modified radical mastectomy patients, 10% developed chest wall recurrences. Five percent of recurrences were first in the axilla and 6% in the supraclavicular nodes. Five-year actuarial survival for the entire patient group was 79% and disease-free survival was 60%, with a median disease-free survival time of 87 months. Five-year local-regional relapse-free survival was 76%. Five-year local-regional relapse-free survival was < 76% for those patients with 4 or more positive axillary nodes, regardless of tumor size. On univariable analysis, positive resection margins, number of positive axillary nodes, menopausal status, and negative estrogen and progesterone receptors were significant for isolated local-regional recurrence. On multivariable analysis, only positive resection margins and negative receptors remained significant. In terms of regional recurrence specifically, negative estrogen and progesterone-receptor status and positive resection margins were, again, prognostically significant. CONCLUSIONS: Postmenopausal women receiving adjuvant tamoxifen who have positive resection margins, > or = 4 positive axillary nodes and/or negative estrogen and progesterone receptors, are at higher risk of local and regional recurrence and should, therefore, receive local-regional radiation.

Adult↗

PubMed1993

Recurrent secretory carcinoma in residual mammary tissue after mastectomy.

A case of secretory carcinoma recurrent in residual breast parenchyma 8 years after modified radical mastectomy is described. The patient, 27 years old at the time of initial diagnosis, was disease free until two chest wall nodules appeared. The recurrent and primary carcinomas were identical and exhibited the mixed solid, papillary, and microacinar growth patterns characteristic of secretory carcinoma. Intraductal and invasive carcinoma involved fibrous tissue and mammary lobules remaining at the site of previous mastectomy. Immunohistochemical staining for alpha-lactalbumin was strongly positive; the carcinoma did not express estrogen or progesterone receptor proteins. Flow cytometric DNA analysis showed a diploid tumor with a synthetic phase of 10%. No further evidence of recurrent carcinoma developed during the ensuing 11 months of follow-up, without adjuvant chemotherapy or radiation. It is important to recognize the morphologic features of this unique form of invasive carcinoma because of its exceptionally good prognosis. Long-term follow-up is mandatory because of the potential for late locoregional recurrence, even after mastectomy.

Adult↗

PubMed1992

[Does the surgical technique modify the incidence of local recurrence after mastectomy?].

This article discusses operative technique in relation to the prevention of local recurrence following modified radical mastectomy (MM) for carcinoma of the breast. As with any other surgical procedure, a satisfactory outcome requires both a correct indication and attention to the details of operative technique. The indications for MM may be defined from the currently accepted contraindications to breast preservation, while most of the contraindications to MM relate to the presence of a stage IIIb or IV carcinoma. The ideal treatment needs to be defined for the individual case, avoiding both unnecessary overtreatment with its associated morbidity and dangerous undertreatment with consequent reduction of the chance for cure. In our view, confirmation of the diagnosis by an excisional biopsy with frozen section examination should be obtained irrespective of a positive finding in an aspirated specimen. The incision for biopsy must be chosen in such a way that it will be encompassed by a subsequent mastectomy incision. When mastectomy is performed the cavity of the excisional biopsy must not be entered. This includes preservation of the barrier of the pectoralis fascia. When breast preservation is an option, the excisional biopsy must fulfill the criteria of a lumpectomy or tumorectomy, which include a 0.5 to 1 cm macroscopically tumor-free margin, orientation of the specimen by sutures, and immersion of the specimen in india ink. As the extent of intraductal component cannot be reliably determined by frozen section examination, waiting for the definitive pathology report may be better than an immediate decision to perform a mastectomy or breast preservation. The skin incision for mastectomy is transverse or slightly oblique, ending laterally about five cm below the axillary pit. The skin flaps must not include the full thickness of the subcutaneous fatty tissue. The preserved layer of fatty tissue must not be irregular. Axillary dissection of levels I and II is sufficient for staging. Skip metastases to level III occur in less than five percent of cases. Therefore routine dissection of level III with its associated increased risk of lymphedema is not justified.

Biopsy↗

PubMed1989

The significance of regional lymph node dissection in the surgical management of breast cancer.

The results of an analysis done on the regional lymph node metastases of 300 patients with operable breast cancer, who were treated in the Department of Surgery (II), Kanazawa University Hospital from 1973 to early 1988 are reported herein. It was found that the metastases of the axillary and internal mammary lymph nodes were closely related to the survival of patients, but they were hardly diagnosed before the operation. Only the dissection of these lymph nodes proved useful for providing the prognostic information. Moreover, in a retrospective study comparing the en bloc extended radical mastectomy versus the other types of mastectomy, the extended radical mastectomy was seen to greatly improve the survival of patients with 3 or less than 3 metastatic axillary lymph nodes. Thus, the extended radical mastectomy provides the maximum diagnostic and prognostic information, and gives the best chance of loco-regional control of the disease. The anterior chest deformity created by the extended radical mastectomy, however, should be avoided in those patients without internal mammary involvement. We therefore propose the modified extended mastectomy as a staging operation.

Adult↗

PubMed1997

Home healthcare for patients receiving one-day mastectomy.

The pressure to cut costs has resulted in outpatient to 1-day hospital stays for women who have a modified radical mastectomy. This article discusses the need for early identification of patients who require home healthcare immediately after surgery to decrease complications and reduce postoperative anxiety.

Ambulatory Surgical Procedures↗

PubMed1998

Residual metastatic axillary lymph nodes following neoadjuvant chemotherapy predict disease-free survival in patients with locally advanced breast cancer.

BACKGROUND: This study was performed to validate the prognostic significance of residual axillary lymph node metastases in patients with locally advanced breast cancer (LABC) treated with neoadjuvant chemotherapy and to analyze other clinicopathologic factors that might be independent predictors of disease-free survival (DFS) in an attempt to identify patients in whom axillary dissection might be omitted. METHODS: One hundred sixty-five assessable patients with LABC were treated in a prospective trial of neoadjuvant chemotherapy utilizing four cycles of 5-fluorouracil, doxorubicin, and cyclophosphamide. Responding patients were treated with segmental mastectomy and axillary dissection or modified radical mastectomy. Patients subsequently received additional chemotherapy followed by irradiation of the breast or chest wall and draining lymphatics. The median follow-up was 35 months. RESULTS: Clinical tumor response to neoadjuvant chemotherapy (P = 0.046) and the number of residual metastatic axillary lymph nodes found at axillary dissection (P = 0.05) were the only independent predictors of DFS. Patients with a complete clinical response had a predictably excellent DFS and those with no change or progressive disease had a poor DFS. In patients with a partial response, the number of residual metastatic lymph nodes further stratified patients with respect to DFS (P = 0.006). CONCLUSIONS: Clinical response and residual metastatic axillary lymph nodes following neoadjuvant chemotherapy are important predictors of DFS. Patients with a clinically positive axilla following neoadjuvant chemotherapy should undergo axillary dissection to ensure local control. However, the benefit of axillary dissection in patients with a clinically negative axilla may be minimal if the axilla will be irradiated, and histologic staging does not affect subsequent systemic treatment. A prospective randomized trial of axillary dissection versus axillary radiotherapy in patients with a clinically negative axilla following neoadjuvant chemotherapy is presently under way to evaluate this hypothesis.

Antineoplastic Combined Chemotherapy Protocols↗