Does regional treatment improve the survival in patients with operable breast cancer?

Background. The impact of regional therapy on survival of patients with invasive breast cancer remains controversial. Regional therapies discussed include axillary lymph node dissection (ALND), internal mammary node dissection, and locoregional radiotherapy. Methods. Prospective randomized clinical studies of regional therapy were reviewed using, as a source, Medline, main review articles on the related topic, and statements from consensus conference. Results. Although a number of randomized clinical studies have failed to demonstrate the benefits of regional treatment for survival, it is still a matter of debate whether ALND or regional radiotherapy alone can have a small but significant beneficial effect on the survival of breast cancer patients. However, recent studies have suggested that survival can be enhanced by interaction of postmastectomy locoregional radiotherapy with adjuvant systemic therapy. Conclusions. Locoregional control is important for enhancing survival in the presence of adjuvant systemic therapy. Although only a few randomized controlled trials show conclusively the survival benefit of local therapies, it is expected that in clinical practice, the node-positive or other high-risk breast cancer patients given systemic treatment will be more frequently treated with postmastectomy radiation.