Regional Lymph Node Radiation Therapy in Breast Cancer

Lymphedema (LE) after breast cancer treatment is an important long-term morbidity, resulting in functional, cosmetic, and psychological problems, all of which may significantly impact quality of life. Radiation therapy (RT) has been found to be a risk factor for the development of breast cancer-related lymphedema (BCRL) in several studies, with a predominant focus on the role of regional lymph node radiation therapy (RLNR). It is likely that an increasing number of patients in the future will receive RLNR due to the recent studies including the lack of benefit and increased morbidity of axillary lymph node dissection (ALND) in patients with positive sentinel lymph nodes and the benefits of RLNR in early-stage and locally advanced breast cancer. RLNR improves survival outcome in small a subset of patients, while exposing patients to high risk of LE. Clinicians should cautiously weigh the potential benefits of RT against the risk of LE in individual patients. In addition, clinical guideline for identifying patients at risk for LE and creating management plan for these patients are needed.