Axillary Lymph Node Dissection versus Axillary Radiation in Patients with Positive Sentinel Lymph Node Biopsy in Early Breast Cancer

Abstract Background: Patients with cancer detected in a sentinel lymph node biopsy have under gone axillary lymph node dissection (ALND), which is an effective but invasive surgical procedure associated with adverse side effects, such as lymph-edema and difficulty moving the arm. Axillary radiation delivers outcomes that are similar to axillary lymph node dissection and with fewer side effects. Aim of Study: To define which patient may benefit from axillary dissection and who may benefit from axillary radiation without the hazards of axillary dissection in Patients with positive sentinel lymph node biopsy in early breast cancer patients. Patients and Methods: The 150 female patients with suc-cessful lymphatic mapping for early breast cancer T1 and T2, who were clinically node-negative,were randomly assigned prior to SLNB to receive either ALND(n=75) or axillary radiotherapy (n=75). The first 75 patients who were positive for SLNB were eligible for ALND (standard level I and II clearance) and the second consecutive positive 75 patients of the study were eligible for axillary radiotherapy. Results: Lymphedema rates were (2.6%) in the axillary dissection group and no arm edema in the axillary radiotherapy group. Long thoracic nerve injury rates were (2%) in the axillary dissection group and no nerve injury in the axillary radiation group, although no other nerve or vascular injuries were reported within two groups. Five year axillary recurrence rates (0.7% ALND vs 0.2% axillary radiotherapy). Most patients received adjuvant chemotherapy (68.6%) and/or endocrine therapy (31.4%) 47. Conclusion: Axillary radiation in patients with sentinel lymph node biopsy positive in early breast cancer may be considered as a standard therapy instead of axillary lymph node dissection.