Abstract: Principles of axillary radiotherapy in early breast cancer          ZHENG Si-yue, CHEN Jia-yi.Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Corresponding author:CHEN Jia-yi, E-mail：cjy11756@rjh.com.cn
Abstract    The principle of axillary management of early breast cancer patients is to pursue precision and safety on the basis of effective disease control. Therefore, replacing axillary lymph node dissection(ALND) with axillary radiotherapy has become the focus in recent years. For patients who did not receive neoadjuvant treatment, patients with negative axillary lymph nodes at first diagnosis or with sentinel lymph node(SLN) micrometastases after breast-conserving surgery do not need ALND or axillary irradiation; patients with one or two SLN metastases after breast-conserving surgery need whole breast or high tangential field irradiation without ALND; patients with more than 2 SLN metastases or a higher risk of ALN metastases, axillary radiotherapy is required after exemption of ALND; currently there is insufficient evidence for SLN-positive patients after mastectomy without ALND, so axillary radiotherapy can be considered. Among patients who received neoadjuvant therapy, ALND can be replaced with axillary radiotherapy if the SLNs turn negative, but is still recommended if the SLNs remain positive.

Key words: early breast cancer, sentinel lymph node, axillary lymph node, radiotherapy

摘要： 早期乳腺癌病人腋窝淋巴结处理的原则是在有效控制疾病的基础上追求精准与安全。因此，以腋窝放疗替代手术成为近年来的关注焦点。在未行新辅助治疗的人群中，腋窝淋巴结初诊阴性或保乳术后前哨淋巴结（SLN）微转移的病人无须追加腋窝淋巴结清扫（ALND）或完整的腋窝照射；保乳术后SLN 1~2枚宏转移可豁免ALND并行全乳或高切线野照射，SLN转移数目＞2枚或SLN外淋巴结转移风险较高者，豁免ALND后需补充腋窝放疗；乳房切除术后SLN阳性病人中目前证据不足，如未行ALND可考虑补充腋窝放疗；在接受了新辅助全身治疗的病人中，如SLN转阴可豁免ALND并补充腋窝放疗，如SLN未转阴目前依然推荐行ALND。

关键词: 早期乳腺癌, 前哨淋巴结, 腋窝淋巴结, 放疗