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Invited Commentary

Joseph P. Crowe Jr, MD
Arch Surg. 1993;128(12):1319. doi:10.1001/archsurg.1993.01420240027003.
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This study addresses the question of whether all patients receiving breast conservation therapy require an axillary dissection. While the authors acknowledge that axillary node status gives prognostic information, they state that axillary dissection may be unnecessary because good local control rates can be achieved by using axillary radiation therapy without surgery and that many patients, regardless of their node status, receive adjuvant therapy outside the protocol setting. There are two issues that deserve comment. First, the authors clearly advocate using axillary radiation therapy when a node dissection is not performed. They state that 15% to 25% of patients with clinically negative axillae will experience a nodal relapse. This implies that 75% to 85% of the patients will not have a nodal relapse and thus, these patients will have received unnecessary axillary radiation. Would it not be more reasonable to spare patients axillary radiation and use axillary dissection selectively to control


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