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Piltin MA, Norwood P, Ladores V, Mukhtar RA, Sauder CA, Golshan M, Tchou J, Rao R, Lee MC, Son J, Reyna C, Hewitt K, Kuerer H, Ahrendt G, Greenwalt I, Tseng J, Postlewait L, Howard-McNatt M, Jaskowiak N, Esserman LJ, Boughey JC. Internal Mammary Lymphadenopathy Does Not Impact Oncologic Outcomes in Patients Treated with Neoadjuvant Chemotherapy: Results from the I-SPY2 Clinical Trial. Ann Surg Oncol 2024:10.1245/s10434-024-15708-9. [PMID: 38980586 DOI: 10.1245/s10434-024-15708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/16/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Internal mammary lymphadenopathy (IML) plays a role in breast cancer stage and prognosis. We aimed to evaluate method of IML detection, how IML impacts response to neoadjuvant chemotherapy (NAC), and oncologic outcomes. METHODS We evaluated patients enrolled in the I-SPY-2 clinical trial from 2010 to 2022. We captured the radiographic method of IML detection (magnetic resonance imaging [MRI], positron emission tomography/computed tomography [PET/CT], or both) and compared patients with IML with those without. Rates of locoregional recurrence (LRR), distant recurrence (DR) and event-free survival (EFS) were compared by bivariate analysis. RESULTS Of 2095 patients, 198 (9.5%) had IML reported on pretreatment imaging. The method of IML detection was 154 (77.8%) MRI only, 11 (5.6%) PET/CT only, and 33 (16.7%) both. Factors associated with IML were younger age (p = 0.001), larger tumors (p < 0.001), and higher tumor grade (p = 0.027). Pathologic complete response (pCR) was slightly higher in the IML group (41.4% vs. 34.0%; p = 0.03). There was no difference in breast or axillary surgery (p = 0.41 and p = 0.16), however IML patients were more likely to undergo radiation (68.2% vs. 54.1%; p < 0.001). With a median follow up of 3.72 years (range 0.4-10.2), there was no difference between IM+ versus IM- in LRR (5.6% vs. 3.8%; p = 0.25), DR (9.1% vs. 7.9%; p = 0.58), or EFS (61.6% vs. 57.2%; p = 0.48). This was true for patients with and without pCR. CONCLUSIONS In this large cohort of patients treated with NAC, outcomes were not negatively impacted by IML. We demonstrated that IML influences treatment selection but is not a poor prognostic indicator when treated with modern NAC and multidisciplinary disease management.
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Affiliation(s)
- Mara A Piltin
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Peter Norwood
- Quantum Leap Healthcare Collaborative, San Francisco, CA, USA
| | - Velle Ladores
- Quantum Leap Healthcare Collaborative, San Francisco, CA, USA
| | - Rita A Mukhtar
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Candice A Sauder
- Department of Surgery, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Mehra Golshan
- Department of Surgery, Yale Medicine, New Haven, CT, USA
| | - Julia Tchou
- Division of Breast Surgery, Penn Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Roshni Rao
- Division of Breast Surgery, Columbia University Medical Center, New York, NY, USA
| | | | - Jennifer Son
- Breast Surgical Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Chantal Reyna
- Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Mayowood, IL, USA
| | - Kelly Hewitt
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashvilee, TN, USA
| | - Henry Kuerer
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Ian Greenwalt
- Breast Surgical Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jennifer Tseng
- Department of Surgery, City of Hope Orange County, Irvine, CA, USA
| | - Lauren Postlewait
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, USA
| | | | - Nora Jaskowiak
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Laura J Esserman
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Qiu PF, Lv Q, Zhao WH, Huang YX, Zhu SG, Zhong H, Yang GL, Bell S, Wang LY, Xu YY, Sun X, Chen YG, Ding Q, Wang YS. Development and validation of a nomogram for predicting internal mammary sentinel node metastasis in breast cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107040. [PMID: 37672825 DOI: 10.1016/j.ejso.2023.107040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/06/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE Internal mammary nodes are important in breast cancer prognosis, but their diagnosis is often missed in clinical practice, leading to inaccurate staging and treatment. We developed a validated nomogram to predict the presence of internal mammary sentinel nodes (IMSN) metastasis. METHODS A total of 864 sequential IMSN biopsy procedures from a prospective studies database of 1505 cases were used for model development and validation. Multivariable logistic regression was performed on 519 sequential IMSN biopsy procedures from multi-center data between August 2018 and July 2022 to predict the presence of IMSN metastasis. A nomogram was developed based on the logistic regression model and subsequently applied to 345 sequential IMSN biopsy procedures from single-center data between November 2011 and July 2018. The model's discrimination was assessed using the area under the receiver operating characteristic curve. RESULTS The overall frequency of IMSN metastasis was 17.0% in our study. A predictive model for IMSN metastasis was constructed using tumor size, tumor location, lymphovascular invasion, the number of positive axillary nodes (P < 0.05 for all variables in multivariate analysis), and histological grade (P < 0.05 only in univariate analysis). The nomogram was accurate, with a concordance index of 0.84 in the bootstrapping analysis and an area under the receiver operating characteristic curve of 0.80 in the validation population. CONCLUSION Our nomogram provides an accurate and validated multivariable predictive model for estimating the individual likelihood of having IMSN metastasis. This may be useful for personalized treatment decisions regarding internal mammary radiotherapy in breast cancer patients.
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Affiliation(s)
- Peng-Fei Qiu
- The First Affiliated Hospital with Nanjing Medical University, 210029, Nanjing, Jiangsu, China; Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China
| | - Qing Lv
- Department of Breast Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Wen-He Zhao
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, 310020, Hangzhou, Zhejiang, China
| | - Yuan-Xi Huang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, 150081, Harbin, Heilongjiang, China
| | - Shi-Guang Zhu
- Department of Breast Surgery, Yantai Yuhuangding Hospital, 264001, Yantai, Shandong, China
| | - Hong Zhong
- Department of Breast and Thyroid Surgery, The 3rd Affiliated Teaching Hospital of Xinjiang Medical University (Affiliated Cancer Hospital), 830011, Urumqi, Xinjiang, China
| | - Guang-Lun Yang
- Department of Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, 40016, Chongqing, China
| | - Steven Bell
- Precision Breast Cancer Institute, Department of Oncology, University of Cambridge, CB2 0QQ, Cambridge, UK
| | - Li-Yang Wang
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, CB2 0QQ, Cambridge, UK
| | - Ying-Ying Xu
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, 110001, Shenyang, Liaoning, China
| | - Xiao Sun
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China
| | - Yu-Guang Chen
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China
| | - Qiang Ding
- The First Affiliated Hospital with Nanjing Medical University, 210029, Nanjing, Jiangsu, China.
| | - Yong-Sheng Wang
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China.
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Andring LM, Diao K, Sun S, Patel M, Whitman GJ, Schlembach P, Arzu I, Joyner MM, Shaitelman SF, Hoffman K, Stauder MC, Smith BD, Woodward WA. Locoregional Management and Prognostic Factors in Breast Cancer Patients with Ipsilateral Internal Mammary and Axillary Lymph Node Involvement. Int J Radiat Oncol Biol Phys 2022; 113:552-560. [PMID: 35248602 DOI: 10.1016/j.ijrobp.2022.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Breast cancer patients with ipislateral axillary and internal mammary (IM) lymph node involvement (cN3b) often forego IM node resection. Therefore, radiation is important for curative therapy. However, prognosis is not well-described in the era of modern systemic therapy and limited data exist to guide optimal locoregional treatment recommendations. METHODS We retrospectively reviewed 117 patients with non-metastatic cN3b breast cancer treated at our institution between 2014-2019. Staging included ultrasound evaluation of all regional nodal basins. All patients received neoadjuvant chemotherapy (NAC), resection of the breast primary and axillary nodal dissection, followed by adjuvant radiation to the breast/chest wall and regional nodes. Institutional guidelines recommend a 10 Gy boost to radiographically resolved nodes, and 16 Gy boost to unresolved nodes. Overall survival (OS), recurrence (RFS), locoregional (LRRFS), internal mammary (IMRFS), and distant metastasis free survival (DMFS) were evaluated with Kaplan Meier analysis. A multivariable model for RFS was constructed. RESULTS Median follow-up for 117 patients was 3.82 years. Median age at diagnosis was 46 years and 56 (48%) patients were receptor group ER+/HER2-. Mastectomy was performed in 96 (82%) of patients, 38 (32%) had biopsy confirmed IMC involvement, and 8 (7%) had IM node dissection. The median initial radiation dose was 50 Gy (range, 50-55) and IMC boost 10 Gy (range, 0-16). The 5-year OS, IMRFS, LRRFS, DMFS, and RFS were 74%, 98%, 89%, 68% and 67% respectively. On multivariable analysis, a clinical complete response (CR) of the IM nodes or pathologic ypN0 status had improved 5-year RFS with HR 0.24 (p=0.006) and HR 0.27 (p=0.05), respectively. Extranodal extension or lymphovascular invasion were associated with worse 5-year RFS with HR 4.13 (p=0.001) and HR 2.25 (p=0.04), respectively. CONCLUSION Multimodality therapy provides excellent locoregional control of 89% at 5 years for cN3b breast cancer patients. Adjuvant radiation yields a 5-year IMRFS of 98%. Clinical and pathologic response of IM nodes are independently prognostic for RFS.
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Affiliation(s)
| | | | | | | | - Gary J Whitman
- Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
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Yang K, Kim H, Choi DH, Park W, Noh JM, Cho WK. Optimal radiotherapy for patients with internal mammary lymph node metastasis from breast cancer. Radiat Oncol 2020; 15:16. [PMID: 32122399 PMCID: PMC7052982 DOI: 10.1186/s13014-020-1464-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to determine the optimal radiotherapy (RT) regimen for patients with clinical metastasis to the internal mammary lymph node (cIMN+) from breast cancer. Methods We retrospectively reviewed the medical records of 84 patients with cIMN+ breast cancer treated with curative surgery, taxane-based chemotherapy, and postoperative RT between January 2009 and December 2014. Postoperative RT was administered to the whole breast or chest wall using 50 Gy in 2 Gy fractions. Boost RT to the internal mammary lymph node (IMN) was administered at the physician’s discretion. We categorized patients into two groups according to the IMN dose as follows: low-dose IMN RT (50.0–63.5 Gy) and high-dose IMN RT (63.6–70.4 Gy). Results After a median follow-up of 58 months (range, 12–111 months), IMN recurrence was observed in 2 patients (2.4%), and all IMN recurrences developed simultaneously with distant metastases. The 5-year locoregional recurrence-free survival, disease-free survival (DFS), and overall survival rates were 89.1, 72.0, and 81.2%, respectively. The triple-negative subtype, IMN size ≥1.0 cm, old age, and low-dose IMN were significantly associated with poor DFS. Among the patients with IMN size ≥1.0 cm, the 5-year DFS was significantly higher in those treated with high-dose IMN RT than in those treated with low-dose IMN RT (69.3% vs. 33.3%, p = 0.019). Conclusions IMN RT without IMN dissection resulted in favorable outcomes in cIMN+ breast cancer. For patients with a large IMN, a higher IMN radiation dose might be needed for disease control.
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Affiliation(s)
- Kyungmi Yang
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea, 06351.
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea, 06351
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea, 06351
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea, 06351
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea, 06351
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Singh S, Ramani SK, Rastogi A, Thakur MH. Incidence of internal mammary node in locally advanced breast cancer and its correlation with metastatic disease: a retrospective observational study. Br J Radiol 2019; 92:20190098. [PMID: 31538515 PMCID: PMC6849683 DOI: 10.1259/bjr.20190098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 09/01/2019] [Accepted: 09/16/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine incidence of internal mammary nodes (IMN) at baseline CT of locally advanced breast cancer (LABC) and ascertain prognostic implication. METHODS AND MATERIALS Retrospective review of all LABC patients from 1 January 2012 through 31 December 2014 was performed after approval from institutional review board. CTs of 182 patients enrolled were reviewed by two radiologists independently, and IMNs were documented based on size, location and relation with location of breast primary. 3-year follow-up was analysed and incidence of metastases was calculated as overall incidence, incidence in patients with and without discernible IMN at baseline imaging. Results are presented as numbers and percentages. Differences in metastases of two groups were compared using χ2 test. 95% CI was calculated and p < 0.05 was considered significant. RESULTS 77 of 182 had identifiable IMN (42.3% incidence). Majority of identifiable nodes were on ipsilateral side of primary (incidence 90.90%) with higher incidence in patients with upper-outer quadrant tumours (55.9%). Majority were seen in second intercostal space (44.4%). 36 (19.7%) developed distant metastases within 3 years of therapy. Of these, 21 (27.3%) had IMN as compared with 15 (14.3 %) without IMN on baseline imaging. Patients with identifiable IMN on baseline CT had significantly higher incidence of distant metastases (p = 0.0321). CONCLUSION Significant number LABC patients have identifiable IMN on baseline imaging with patients showing IMN on baseline CT showing significantly higher rate of metastatic disease following therapy. ADVANCES IN KNOWLEDGE Many LABC patients have identifiable IMNs on baseline imaging which show higher incidence of subsequent metastatic disease.
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Affiliation(s)
- Somesh Singh
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India
| | - Subhash K Ramani
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India
| | - Ashita Rastogi
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India
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Kim K, Kim SS, Shin KH, Kim JH, Ahn SD, Choi DH, Park W, Lee SY, Chun M, Kim JH, Kim YB, Cha J, Park HJ, Lee DS, Jung W. Aggressive Surgical Excision of Supraclavicular Lymph Node Did Not Improve the Outcomes of Breast Cancer With Supraclavicular Lymph Node Involvement (KROG 16-14). Clin Breast Cancer 2019; 20:51-60. [PMID: 31629642 DOI: 10.1016/j.clbc.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the outcomes of upfront surgery followed by radiation therapy (RT) for ipsilateral supraclavicular (SCN) and/or internal mammary (IMN) node-positive breast cancer. MATERIALS AND METHODS One hundred fifty-eight patients were included; among these, 91 patients were SCN-positive, 54 were IMN-positive, and 13 were SCN- and IMN-positive. Patients underwent breast conserving surgery (n = 74) or mastectomy (n = 84) followed by systemic therapy, and adjuvant RT to whole breast/chest wall with or without regional nodal RT. Regarding regional treatments for SCN and IMN, SCN excision was performed in 59 (37.3%) patients, IMN excision in 10 (6.3%) patients, SCN RT in 143 (90.5%) patients, and IMN RT in 68 (43.0%) patients. RESULTS The median duration of follow-up was 72 months (range, 7-182 months). There were 20 locoregional recurrences and 45 distant metastases. In-field failure was observed only in SCN (n = 8), and 6 of these patients initially underwent SCN excision. The 5-year locoregional recurrence-free survival, disease-free survival (DFS), and overall survival rates were 87.3%, 71.6%, and 89.7%, respectively. Neither SCN excision nor SCN RT dose ≥ 54 Gy improved locoregional control (P = .927 and P = .693, respectively) or DFS (P = .394 and P = .686, respectively). Having ≥ 10 involved axillary lymph nodes was the only independent prognosticator for DFS after adjusting for covariates (P = .003). CONCLUSION Regional control rate in initially involved SCN and/or IMN was acceptable in patients treated with upfront surgery followed by systemic therapy plus adjuvant RT. More aggressive regional therapy such as SCN excision did not improve locoregional control or survival.
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Affiliation(s)
- Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jihye Cha
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Dong Soo Lee
- Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Wonguen Jung
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Kim K, Jeong Y, Shin KH, Kim JH, Ahn SD, Kim SS, Suh CO, Kim YB, Choi DH, Park W, Cha J, Chun M, Lee DS, Lee SY, Kim JH, Park HJ, Jung W. Impact of Regional Nodal Irradiation for Breast Cancer Patients with Supraclavicular and/or Internal Mammary Lymph Node Involvement: A Multicenter, Retrospective Study (KROG 16-14). Cancer Res Treat 2019; 51:1500-1508. [PMID: 30913866 PMCID: PMC6790841 DOI: 10.4143/crt.2018.575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/13/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the treatment outcomes of radiotherapy (RT) for breast cancer with ipsilateral supraclavicular (SCL) and/or internal mammary (IMN) lymph node involvement. Materials and Methods A total of 353 patients from 11 institutions were included. One hundred and thirty-six patients had SCL involvement, 148 had IMN involvement, and 69 had both. All patients received neoadjuvant systemic therapy followed by breast-conserving surgery or mastectomy, and postoperative RT to whole breast/chest wall. As for regional lymph node irradiation, SCL RT was given to 344 patients, and IMN RT to 236 patients. The median RT dose was 50.4 Gy. Results The median follow-up duration was 61 months (range, 7 to 173 months). In-field progression was present in SCL (n=20) and/or IMN (n=7). The 5-year disease-free survival (DFS) and overall survival rates were 57.8% and 75.1%, respectively. On multivariate analysis, both SCL/IMN involvement, number of axillary lymph node ≥ 4, triple-negative subtype, and mastectomy were significant adverse prognosticators for DFS (p=0.022, p=0.001, p=0.001, and p=0.004, respectively). Regarding the impact of regional nodal irradiation, SCL RT dose ≥ 54 Gy was not associated with DFS (5-year rate, 52.9% vs. 50.9%; p=0.696) in SCL-involved patients, and the receipt of IMN RT was not associated with DFS (5-year rate, 56.1% vs. 78.1%; p=0.099) in IMN-involved patients. Conclusion Neoadjuvant chemotherapy followed by surgery and postoperative RT achieved an acceptable in-field regional control rate in patients with SCL and/or IMN involvement. However, a higher RT dose to SCL or IMN RT was not associated with the improved DFS in these patients.
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Affiliation(s)
- Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yuri Jeong
- Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihye Cha
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Dong Soo Lee
- Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea
| | - Wonguen Jung
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
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Campos TPRD, Mendes BM, Trindade B, Araujo WL. Cardiac risk and MCNP/SISCODES doses in RT of the left internal mammary chain with photon and electron portals. Rep Pract Oncol Radiother 2018; 23:384-391. [DOI: 10.1016/j.rpor.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/18/2017] [Accepted: 07/07/2018] [Indexed: 11/26/2022] Open
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Wang K, Zhang X, Zheng K, Yin XD, Xing L, Zhang AJ, Shi Y, Kong LQ, Li F, Ma BL, Li H, Liu JP, Jiang J, Ren GS, Li HY. Predictors of internal mammary lymph nodes (IMLN) metastasis and disease-free survival comparison between IMLN-positive and IMLN-negative breast cancer patients: Results from Western China Clinical Cooperation Group (WCCCG) database (CONSORT). Medicine (Baltimore) 2018; 97:e11296. [PMID: 29995764 PMCID: PMC6076024 DOI: 10.1097/md.0000000000011296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Limited studies performed a comprehensive assessment of risk factors for internal mammary lymph nodes (IMLN) metastasis, and disease-free survival (DFS) difference between IMLN-positive and IMLN-negative breast cancer (BC) patients undergoing IMLN dissection and systemic therapies was not clear.A retrospective study included 1977 BC patients from Western China Clinical Cooperation Group between January 2005 and December 2012. The impact of clinicopathological factors on the occurrence of IMLN metastasis was assessed in univariate and multivariate logistic regression analyses, and a nomogram (model) was constructed to predict the IMLN status. DFS difference was evaluated in univariate and multivariate Cox regression analyses between IMLN-negative and IMLN-positive patients, and univariate analysis was performed to compare DFS between individuals with high and low IMLN metastasis risk defined by proposed nomogram.Of 1977 enrolled patients, 514 cases underwent IMLN dissection and 1463 cases did not undergo IMLN irradiation or dissection. We found that initial disease symptoms and signs, mammographic calcification, tumor site, number of positive axillary lymph nodes (ALNs), American Joint Committee on Cancer pT stage, and human epidermal growth factor receptor 2 status were associated with IMLN metastasis (all P < .05). Those variables were included in nomogram, whose predictive ability was better than that of ALN classification (area under the curve: 0.82 vs 0.76, P < .001). Univariate cox proportional hazards model indicated that better DFS was observed in IMLN-negative patients than IMLN-positive group (hazard ratio [HR] = 1.87, 95% confidence interval [CI] = 1.05-3.34; P = .04), whereas no significant differences in DFS (HR = 0.99, 95% CI = 0.49-2.00; P = .97) were found after adjusting patient-, disease-, and treatment-related factors.Nipple inversion, mammographic calcification, larger tumor size, medial tumor site, negative HER-2 status, and more positive ALNs are independent risk factors for IMLN metastasis, and the individualized nomogram is a feasible tool to predict the status of IMLN. Equivalent DFS was found between positive and negative IMLN patients who all accepted IMLN dissection and systemic therapies.
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Affiliation(s)
- Kang Wang
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
| | - Xiang Zhang
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
| | - Ke Zheng
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
| | - Xue-Dong Yin
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
| | - Lei Xing
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
| | - Ai-Jie Zhang
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
| | - Yang Shi
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan
| | - Ling-Quan Kong
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
| | - Fan Li
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
| | - Bin-Lin Ma
- Department of Breast and Neck Surgery, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang
| | - Hui Li
- Department of Breast Surgery, Sichuan Province Tumor Hospital
| | - Jin-Ping Liu
- Department of Breast Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan
| | - Jun Jiang
- Breast Disease Center, Southwest Hospital, Third Military Medical University
| | - Guo-Sheng Ren
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong-Yuan Li
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
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Nguyen MH, Lavilla M, Kim JN, Fang LC. Cardiac sparing characteristics of internal mammary chain radiotherapy using deep inspiration breath hold for left-sided breast cancer. Radiat Oncol 2018; 13:103. [PMID: 29855325 PMCID: PMC5984301 DOI: 10.1186/s13014-018-1052-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While breast radiotherapy typically includes regional nodal basins, the treatment of the internal mammary nodes (IMN) has been controversial due to concern for long-term cardiac toxicity. For high risk patients where IMN treatment is warranted, there is limited data with regards to the degree of heart sparing conferred by modern techniques. In this study, we sought to analyze the specific heart sparing metrics conferred by deep inspiration breath hold (DIBH) in the setting of IMN irradiation. METHODS From 2012 to 2015, 168 consecutive patients were treated with adjuvant left-sided radiotherapy using DIBH. Retrospective review identified 49 patients who received nodal irradiation, either to a supraclavicular field (SCF) and IMN (16), or to the SCF alone (33). Cardiac mean dose and dose volumes were calculated from free breathing (FB) and DIBH treatment plans, and compared by Wilcoxon signed-rank and Mann-Whitney U tests. RESULTS DIBH achieved significant reductions in mean heart dose (p < 0.001) in both the IMN treated group from 6.73 Gy to 2.79 Gy (- 56.4%) and the IMN untreated group from 4.77 Gy to 1.55 Gy (- 63.7%). There was a 7.3% difference in relative reduction that was not statistically significant (p = 0.216). Relative reductions in heart dose volume measures were all significantly lower for IMN-irradiated patients (p ≤ 0.012), with the greatest deficits at V5 that gradually diminish with increasing dose (V25). CONCLUSIONS The relative heart sparing benefits of the DIBH technique are retained even with IMN inclusion. However, the addition of IMN irradiation is associated with an intrinsically greater heart dose, which translates to an estimated 9.2% proportional increase in the risk of a subsequent major coronary event. In the setting of effective cardiac sparing techniques, clinicians should take these considerations into account to guide when IMN treatment is warranted.
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Affiliation(s)
- Macklin H Nguyen
- School of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Myra Lavilla
- Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Seattle, WA, 98109, USA
| | - Janice N Kim
- Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Seattle, WA, 98109, USA.,Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - L Christine Fang
- Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Seattle, WA, 98109, USA.,Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
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11
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Cataliotti L, Ciatto S, Rosselli Del Turco M, Distante V. New Trends in the Surgical Treatment of Primary Breast Cancer in the Florence District: 1979-1985. TUMORI JOURNAL 2018; 72:581-4. [PMID: 3810865 DOI: 10.1177/030089168607200607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors report on a consecutive series of 1979 TIS-T1A-T2A-T3A breast cancer cases surgically treated from 1979 to 1985. The study investigates the impact of recent reports on conservative surgery and of a national treatment protocol for breast cancer, encouraging the use of modified radical mastectomy (MRM) and quadrantectomy, axillary dissection and breast irradiation (QUART) as alternatives to Halsted's radical mastectomy (RM). RM frequency dropped from 52% to 8% in TIS-T1A and from 82% to 20% in T2A-T3A cases in the study period, in favor of MRM and of QUART, which increased from 10% to 54% in TIS-T1A cases. Although surgical choices differ widely according to individual surgeons, a definite trend towards more conservative surgery is evident, which demonstrates how the national treatment protocol has affected current surgical practice.
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12
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Casara D. The Role of Internal Mammary Lymphoscintigraphy in the Clinical Staging and Prognosis of Patients with Breast Cancer. TUMORI JOURNAL 2018; 83:526-9. [PMID: 9226010 DOI: 10.1177/030089169708300206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D Casara
- Radiotherapy Department, Padua General Hospital, Italy
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13
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Clinical significance of internal mammary lymph node metastasis for breast cancer: Analysis of 337 breast cancer patients. Surg Oncol 2018; 27:185-191. [PMID: 29937170 DOI: 10.1016/j.suronc.2018.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/07/2018] [Accepted: 03/26/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Internal mammary nodes (IMNs) is a major pathway of lymphatic drainage for breast cancer, apart from axillary lymph node (ALN). However, owing to lack of a feasible and safe biopsy method, management of IMNs is still controversial in breast surgery. METHODS From 2005 to 2009, a total of 337 consecutive breast cancer women patients were recruited. All patients underwent IMNs biopsy through intercostal space or endoscopic lymphatic chain resection. The ER, PR and HER-2 status were retested according to the current ASCO/CAP guidelines. We analyzed the relationship between clinical pathological parameters and IMNs metastasis and investigated the high risk factors and prognostic values of IMNs metastasis in breast cancer. RESULTS Among 337 patients, 314 patients underwent intercostal space IMNs biopsy and 23 patients underwent endoscopic lymphatic chain resection. A total of 63 (18.69%) patients were pathologically diagnosed with IMNs metastasis. Among them, 28 (44.44%) patients changed the pathological lymph node staging, and 15 cases (23.81%) changed the postoperative comprehensive treatment program and accepted extended postoperative radiotherapy. Multivariate analysis showed that compared with no ALN involvement, the risk of IMNs metastasis was significantly increased in patients with 1-3 ALN involvement (OR = 42.097, 95% CI = 5.225-339.178; P = 0.0004) and ≥4 ALN involvement (OR = 82.429, 95%CI = 10.134-670.496; P < 0.0001). The risk of IMNs metastasis in HER-2 positive patients was significantly higher than that in negative patients (OR = 5.452, 95% CI = 2.353-12.634; P < 0.0001). However, we did not find IMNs involvement was an independent indicator for both overall survival and disease-free survival. CONCLUSIONS Our clinical practice and data indicated that IMNs biopsy through intercostal space and endoscopic lymphatic chain resection are effective and minimally invasive methods to detect the IMNs status, which may be helpful for accurate tumor staging, risk assessment and option of chemotherapy or radiotherapy to improve the patients' survival.
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14
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Validation study for the hypothesis of internal mammary sentinel lymph node lymphatic drainage in breast cancer. Oncotarget 2018; 7:41996-42006. [PMID: 27248827 PMCID: PMC5173111 DOI: 10.18632/oncotarget.9634] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/09/2016] [Indexed: 02/06/2023] Open
Abstract
According to axilla sentinel lymph node lymphatic drainage pattern, we hypothesized that internal mammary sentinel lymph node (IM-SLN) receives lymphatic drainage from not only the primary tumor area, but also the entire breast parenchyma. Based on the hypothesis a modified radiotracer injection technique was established and could increase the visualization rate of the IM-SLN significantly. To verify the hypothesis, two kinds of tracers were injected at different sites of breast. The radiotracer was injected with the modified technique, and the fluorescence tracer was injected in the peritumoral intra-parenchyma. The location of IM-SLN was identified by preoperative lymphoscintigraphy and intraoperative gamma probe. Then, internal mammary sentinel lymph node biopsy (IM-SLNB) was performed. The fluorescence status of IM-SLN was identified by the fluorescence imaging system. A total of 216 patients were enrolled from September 2013 to July 2015. The overall visualization rate of IM-SLN was 71.8% (155/216). The success rate of IM-SLNB was 97.3% (145/149). The radiotracer and the fluorescence tracer were identified in the same IM-SLN in 127 cases, the correlation and the agreement is significant (Case-base, rs=0.836, P<0.001; Kappa=0.823, P<0.001). Different tracers injected into the different sites of the intra-parenchyma reached the same IM-SLN, which demonstrates the hypothesis that IM-SLN receives the lymphatic drainage from not only the primary tumor area but also the entire breast parenchyma.
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15
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Sachdev S, Goodman CR, Neuschler E, Kalakota K, Cutright D, Donnelly ED, Hayes JP, Prescott AE, Mirabelli G, Strauss JB. Radiotherapy of MRI-detected involved internal mammary lymph nodes in breast cancer. Radiat Oncol 2017; 12:199. [PMID: 29258542 PMCID: PMC5735526 DOI: 10.1186/s13014-017-0934-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The internal mammary (IM) lymph node chain, along with the axillary nodal basin, is a first-echelon breast lymphatic draining site. A growing body of evidence supports irradiation of this region in node-positive breast cancer. This study evaluated the effectiveness of radiotherapy in treating magnetic resonance imaging (MRI)-detected abnormal IM lymph nodes in newly-diagnosed non-metastatic breast cancer. METHODS A structured query was performed on an electronic institutional database to identify women with radiographic evidence of abnormal IM node(s) on breast MRI from 2005 to 2013. Manual review narrowed inclusion to patients with a primary diagnosis of non-metastatic breast cancer with abnormal IM node(s) based on pathologic size criteria and/or abnormal enhancement. RESULTS Of the 7070 women who underwent pre-treatment MRI, 19 (0.3%) were identified on imaging to have a total of 25 abnormal pre-treatment IM lymph nodes, of which 96% were located in the first two intercostal spaces and 4% in the third space. A majority of the primary tumors were high-grade (94.7%) and hormone-receptor negative (73.7%), while 47.4% overexpressed HER-2/neu receptor. Axillary nodal disease was present in 89.5% of patients, while one patient had supraclavicular involvement. At a median follow-up of 38 months, 31.6% of patients had developed metastatic disease and 21.1% had died from their disease. Of the patients who received IM coverage, none had progressive disease within the IM lymph node chain. CONCLUSIONS Radiologic evidence of pre-treatment abnormal IM chain lymph nodes was associated with advanced stage, high grade, and negative estrogen receptor status. The majority of positive lymph nodes were located within the first two intercostal spaces, while none were below the third. Radiation of the IM chain in combination with modern systemic therapy was effective in achieving locoregional control without surgical resection in this cohort of patients.
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Affiliation(s)
- Sean Sachdev
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA
| | - Chelain R Goodman
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA
| | - Erin Neuschler
- Division of Breast Imaging, Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St Clair Street #800, Chicago, IL, 60611, USA
| | - Kapila Kalakota
- Radiation Oncology Consultants Ltd., 120 N. Oak Street, Hinsdale, IL, 60521, USA
| | - Daniel Cutright
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA
| | - Eric D Donnelly
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA
| | - John P Hayes
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA
| | - Adam E Prescott
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA
| | - Gianna Mirabelli
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA
| | - Jonathan B Strauss
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA.
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Mathieu D, Shahvary N, Côté N, Boulva K, Meloche-Dumas L, Vu T, Patocskai E, Bernier C, Roberge D, Fortin I. Helical Tomotherapy for Postmastectomy Radiotherapy after Immediate Left Breast Reconstruction: A Case Study. Cureus 2017; 9:e1462. [PMID: 28936374 PMCID: PMC5595269 DOI: 10.7759/cureus.1462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 43-year-old premenopausal female presented with a multicentric infiltrating lobular carcinoma of the left breast with axillary nodes metastasis. She underwent modified radical mastectomy with axillary lymph node dissection (level I and II) followed by a mixed autologous latissimus dorsi flap reconstruction with the addition of prosthesis. The final pathological analysis revealed a 6 cm invasive lobular carcinoma pT3N2aM0, grade III/III, estrogen and progesterone positive, human epidermal growth factor receptor 2 (HER2) negative, with 5/16 positive lymph nodes. She received neoadjuvant chemotherapy with doxorubicin and cyclophosphamide followed by paclitaxel. Post-mastectomy radiotherapy with axillary, supraclavicular and internal mammary lymph nodes (IMLN) irradiation was delivered to a dose of 50 Gy/25 fx. In this case with multiple risk factors for radiation-induced cardiac toxicity (left-sided lesion, internal mammary lymph nodes (IMLN) irradiation), we discuss the role of helical tomotherapy as a treatment alternative to conventional tangential radiotherapy.
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Affiliation(s)
- Dominique Mathieu
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Nazanin Shahvary
- Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Nicolas Côté
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Kerianne Boulva
- Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Léamarie Meloche-Dumas
- Département De Chirurgie Oncologique, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Toni Vu
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Erica Patocskai
- Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Christina Bernier
- Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM)
| | - David Roberge
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Israel Fortin
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
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Hwang KT, Kim J, Kim EK, Jung SH, Sohn G, Kim SI, Jeong J, Lee HJ, Park JH, Oh S, Ahn SH, Noh DY, Nam SJ, Lee ES, Park BW, Noh WC, Yoon JH, Lee SJ, Lee EK, Jeong J, Han S, Park HY, Paik NS, Bae YT, Lee HJ, Park HK, Ko SS, Song BJ, Suh YJ, Jung SH, Cho SH, Kim SJ, Oh SJ, Ko BK, Kim KS, Park C, Baek JM, Hwang KT, Chang IS, Bae JW, Kim JS, Kang SH, Gwak G, Lee JH, Kim TH, Chang M, Kim SY, Lee JS, Song JY, Park HL, Min SY, Yang JH, Park SH, Park WC, Kim LS, Ryu DW, Kim KC, Chung MS, Park HB, Lim CW, Choi UJ, Kwak BS, Park YS, Shin HJ, Choi YJ, Kim D, Han A, Koh JH, Choi S, Yoon D, Choi SY, Chul SH, Kim JI, Choi JH, Ryu JW, Ko CD, Lee IK, Lee DS, Choi S, Min YK, Jeon YS, Park EH. Poor Prognosis of Lower Inner Quadrant in Lymph Node–negative Breast Cancer Patients Who Received No Chemotherapy: A Study Based on Nationwide Korean Breast Cancer Registry Database. Clin Breast Cancer 2017; 17:e169-e184. [DOI: 10.1016/j.clbc.2016.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/26/2016] [Indexed: 11/29/2022]
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Kanyilmaz G, Aktan M, Koc M, Demir H, Demir LS. Unplanned irradiation of internal mammary lymph nodes in breast cancer. Radiol Med 2017; 122:405-411. [PMID: 28255809 DOI: 10.1007/s11547-017-0747-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
AIMS To evaluate the incidental dose to the internal mammary chain (IMC) in patients treated with three-dimensional conformal radiotherapy, to estimate the predictors affecting the magnitude of IMC receiving dose and to determine the predictive role of clinical parameters on survival. MATERIALS AND METHODS Between 2009 and 2015, 348 patients undergoing RT for breast cancer were retrospectively analyzed. All patients underwent our department's routine procedure for breast cancer. The internal mammary lymph nodes were contoured according to Radiation Therapy Oncology Group (RTOG) concensus. Based on each patient's dose-volume histograms, the mean doses (D mean) to internal mammary gland were analyzed. Overall survival and disease-free survival were also evaluated. RESULTS The median follow-up time was 38 (range 3-80) months. The D mean to IMC was 32.8 Gy and the dose delivered to IMC showed a greater coverage in modified radical mastectomy (MRM) group compared with breast conserving surgery (34.6 vs 26.7 Gy). The T-stage of tumor and the N-stage of tumor affected the incidental dose to IMC. The tumor size, the number of involved lymph nodes, the percentage of involved lymph nodes, hormonal status, advanced T-stage and advanced N-stage were the prognostic factors that affect survival. CONCLUSION The IMC received meaningful incidental irradiation dose when treated with two opposite tangential fields and ipsilateral supraclavicular fossa with a single anterior field. The real effect of incidental dose on survival and the hypothesis about the benefit of incidental irradiation of IMC should be examined in clinical studies.
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Affiliation(s)
- Gul Kanyilmaz
- Department of Radiation Oncology, Necmettin Erbakan University Meram Medicine School, Akyokus Mevkii, 42090, Konya, Turkey.
| | - Meryem Aktan
- Department of Radiation Oncology, Necmettin Erbakan University Meram Medicine School, Akyokus Mevkii, 42090, Konya, Turkey
| | - Mehmet Koc
- Department of Radiation Oncology, Necmettin Erbakan University Meram Medicine School, Akyokus Mevkii, 42090, Konya, Turkey
| | - Hikmettin Demir
- Department of Radiation Oncology, Necmettin Erbakan University Meram Medicine School, Akyokus Mevkii, 42090, Konya, Turkey
| | - Lütfi Saltuk Demir
- Department of Public Health and Biostatistics, Necmettin Erbakan University Meram Medicine School, Konya, Turkey
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Tan C, Caragata R, Bennett I. Is Sentinel Node Biopsy of the Internal Mammary Lymph Nodes Relevant in the Management of Breast Cancer? Breast J 2017; 23:410-414. [DOI: 10.1111/tbj.12754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chuan Tan
- Breast and Endocrine Surgery Unit; Princess Alexandra Hospital; Wolloongabba Queensland Australia
| | - Rebecca Caragata
- Breast and Endocrine Surgery Unit; Princess Alexandra Hospital; Wolloongabba Queensland Australia
| | - Ian Bennett
- Breast and Endocrine Surgery Unit; Princess Alexandra Hospital; Wolloongabba Queensland Australia
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20
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Conservative Surgery. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Internal mammary sentinel lymph node biopsy in clinical practice. Int J Surg 2016; 36:332-334. [DOI: 10.1016/j.ijsu.2016.11.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 10/26/2016] [Accepted: 11/10/2016] [Indexed: 11/18/2022]
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22
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Leite ETT, Ugino RT, Santana MA, Ferreira DV, Lopes MR, Pelosi EL, da Silva JLF, Carvalho HDA. Incidental irradiation of internal mammary lymph nodes in breast cancer: conventional two-dimensional radiotherapy versus conformal three-dimensional radiotherapy. Radiol Bras 2016; 49:170-5. [PMID: 27403017 PMCID: PMC4938447 DOI: 10.1590/0100-3984.2015.0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate incidental irradiation of the internal mammary lymph nodes (IMLNs) through opposed tangential fields with conventional two-dimensional (2D) or three-dimensional (3D) radiotherapy techniques and to compare the results between the two techniques. MATERIALS AND METHODS This was a retrospective study of 80 breast cancer patients in whom radiotherapy of the IMLNs was not indicated: 40 underwent 2D radiotherapy with computed tomography for dosimetric control, and 40 underwent 3D radiotherapy. The total prescribed dose was 50.0 Gy or 50.4 Gy (2.0 or 1.8 Gy/day, respectively). We reviewed all plans and defined the IMLNs following the Radiation Therapy Oncology Group recommendations. For the IMLNs, we analyzed the proportion of the volume that received 45 Gy, the proportion of the volume that received 25 Gy, the dose to 95% of the volume, the dose to 50% of the volume, the mean dose, the minimum dose (Dmin), and the maximum dose (Dmax). RESULTS Left-sided treatments predominated in the 3D cohort. There were no differences between the 2D and 3D cohorts regarding tumor stage, type of surgery (mastectomy, breast-conserving surgery, or mastectomy with immediate reconstruction), or mean delineated IMLN volume (6.8 vs. 5.9 mL; p = 0.411). Except for the Dmin, all dosimetric parameters presented higher mean values in the 3D cohort (p < 0.05). The median Dmax in the 3D cohort was 50.34 Gy. However, the mean dose to the IMLNs was 7.93 Gy in the 2D cohort, compared with 20.64 Gy in the 3D cohort. CONCLUSION Neither technique delivered enough doses to the IMLNs to achieve subclinical disease control. However, all of the dosimetric parameters were significantly higher for the 3D technique.
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Affiliation(s)
- Elton Trigo Teixeira Leite
- MD, Radiation Oncologist, Radiation Oncology Department - Hospital Sírio-Libanês; Radiation Oncology Department - Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Rafael Tsuneki Ugino
- MD, Radiation Oncologist, Radiation Oncology Department - Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Marco Antônio Santana
- MD, Radiation Oncologist, Department of Radiology and Oncology - Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Denis Vasconcelos Ferreira
- MD, Radiation Oncologist, Department of Radiology and Oncology - Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Maurício Russo Lopes
- MD, Radiation Oncologist, Radiation Oncology Department - Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Edilson Lopes Pelosi
- MD, Radiation Oncologist, Radiation Oncology Department - Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Heloisa de Andrade Carvalho
- MD, PhD, Department of Radiology and Oncology - Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Khalifa J, Duprez-Paumier R, Filleron T, Lacroix Triki M, Jouve E, Dalenc F, Massabeau C. Outcome of pN0 Triple-Negative Breast Cancer with or without Lymph Node Irradiation: A Single Institution Experience. Breast J 2016; 22:510-9. [PMID: 27261365 DOI: 10.1111/tbj.12626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The optimal management of patients with pathologically node-negative triple-negative breast cancer (pN0 TNBC) remains unclear. We hypothesized that lymph node irradiation (LNI; internal mammary chain/periclavicular irradiation) had an impact on outcomes of pN0 TNBC. A cohort of 126 consecutive patients with pN0 TNBC treated between 2007 and 2010 at a single institute were included. All radiotherapy (breast/chest wall, ±LNI) was delivered adjuvantly, following completion of surgery ± chemotherapy. Tumors were reviewed and histologic features were described. Tissue microarrays were constructed and tumors were assessed by immunohistochemistry using antibodies against ER, PR, HER2, Ki-67, cytokeratins 5/6, 14, epidermal growth factor receptor and androgen receptor. Patients were divided into two groups for statistical analysis: LNI (LNI+) or no LNI (LNI-). We focused on disease-free survival (DFS), metastasis-free survival (MFS), and overall survival (OS). Fifty-seven and 69 patients received or not LNI, respectively. Median age was 52 (range [25-76]) and 55 (range [29-79]) in LNI+ and LNI- group (p = 0.23). LNI was associated with larger tumors (p = 0.033), central/internal tumors (33 versus 4, p < 0.01) and more chemotherapy (86% versus 59.4% p < 0.01). The median follow-up was 53.5 months. The rate of first regional relapse (associated or not with distant relapse) was low in both groups. There was no difference in 4-year DFS (82.2% versus 89.9%; p = 0.266), MFS (87.0% versus 91.1%; p = 0.286) and OS (85.8% versus 89.9%; p = 0.322) between LNI+ and LNI- group, respectively. In univariate analysis, only clinical size (T >10 mm versus ≤10 mm), histologic size (pT >10 mm versus ≤10 mm) and grade 3 (versus grade 2) were found to be significantly associated with shorter DFS. Omission of LNI in patients with pN0 TNBC does not seem to result in poorer outcome. Further studies are needed to specifically evaluate LNI in pN0 TNBC with histologic grade 3 and/or (p)T >10 mm.
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Affiliation(s)
- Jonathan Khalifa
- Department of Radiation Oncology, Institut Claudius Regaud / Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, Cedex, France
| | - Raphaelle Duprez-Paumier
- Department of Pathology, Institut Claudius Regaud / Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, Cedex, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud / Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, Cedex, France
| | - Magali Lacroix Triki
- Department of Pathology, Institut Claudius Regaud / Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, Cedex, France
| | - Eva Jouve
- Department of Surgical Oncology, Institut Claudius Regaud / Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, Cedex, France
| | - Florence Dalenc
- Département of Medical Oncology, Institut Claudius Regaud / Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, Cedex, France
| | - Carole Massabeau
- Department of Radiation Oncology, Institut Claudius Regaud / Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, Cedex, France
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Dess RT, Speers CW, Pierce LJ. Regional Nodal Radiotherapy in Early-Stage Breast Cancer: Where Are We in 2016? CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Huang JJ, Wu CW, Allen RJ, Shen SC, Yu CC, Cheng MH. Routine sampling of internal mammary lymph nodes during microsurgical breast reconstruction-Experience based on 524 microsurgical breast reconstructions. J Surg Oncol 2016; 114:133-9. [DOI: 10.1002/jso.24295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Jung-Ju Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Chih-Wei Wu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Robert J. Allen
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Shih-Che Shen
- Department of General Surgery, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Chi-Chang Yu
- Department of General Surgery, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
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26
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Yin K, Zhou L, Shao Z, Yin W, Lu J. Clinical significance of locoregional and systemic treatment in operable high-risk breast cancer patients with more than four positive axillary lymph nodes. Onco Targets Ther 2015; 8:2665-73. [PMID: 26442757 PMCID: PMC4590555 DOI: 10.2147/ott.s88216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose Breast cancer cases with four or more involved axillary lymph nodes (ALNs) feature an aggressive clinical history despite intensive treatment. However, therapies for improving the prognosis for these high-risk patients and the prognostic role of clinical characteristics have been little investigated. Therefore, we sought to assess potential prognostic factors for these patients in female Chinese patients and identify the treatment modalities they might benefit from, which offers implications for clinical practice. Patients and methods A total of 518 patients with four or more involved ALNs were retrospectively analyzed. Survival-curve analysis was performed with the Kaplan–Meier method, and Cox proportional hazard regression was applied to identify independent variables for disease-free survival (DFS) and overall survival (OS). Results The patients were divided into groups depending on the number of ALNs, with 38.22% having four to six positive ALNs and 61.78% having seven or more ALNs. Compared with the seven or more-positive ALN subgroup, patients with four to six positive ALNs tended to have smaller tumors and were more likely to undergo modified radical mastectomy rather than radical mastectomy (both P<0.001). Univariate analysis revealed that a fluorouracil/doxorubicin (epirubicin)/cyclophosphamide (CA[E]F) regimen or a CA(E)F followed by docetaxel (CA[E] F > T) regimen conferred significantly better DFS (P=0.0075) and OS (P<0.0001) than those achieved from a cyclophosphamide/methotrexate/fluorouracil regimen, which was almost completely generated by the seven or more ALN subgroup (P=0.0088 and P=0.0001, respectively). Postoperative radiotherapy was associated with better DFS (P=0.0360), which was also generated by the seven or more ALN subgroup (P=0.0107). Subgroup analysis also clarified that the type of surgery conferred a modest effect on DFS in the seven or more ALN subgroup (P=0.0305). Multivariate survival analysis revealed that ALN status (hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.31–3.05; P=0.001), tumor size (HR 1.48, 95% CI 1.06–2.08; P=0.022), and type of surgery (HR 0.47, 95% CI 0.30–0.74; P=0.001) were independent prognostic factors for DFS. Meanwhile, ALN status (HR 2.96, 95% CI 1.51–5.77; P=0.002), tumor size (HR 2.32, 95% CI 1.38–3.89; P=0.001), type of surgery (HR=0.39, 95% CI 0.20–0.76; P=0.006), and regimen of chemotherapy (HR=0.64, 95% CI 0.50–0.85; P=0.002) were identified as independent prognostic factors for OS. Conclusion Besides the classical prognostic factors and the improvement of prognosis achieved from the anthracycline-based or anthracycline–taxane combination chemotherapy compared to cyclophosphamide/methotrexate/fluorouracil chemotherapy, our findings showed benefits on DFS and OS for appropriate local treatments, including radiotherapy and sufficient ALN dissection for high-risk breast cancer patients with four or more ALNs involved, which suggests that much importance should also be attached to local treatment besides adjuvant systemic therapy.
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Affiliation(s)
- Kai Yin
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Liheng Zhou
- Breast Cancer Center, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Wenjin Yin
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Jinsong Lu
- Breast Cancer Center, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
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Matsuzawa F, Omoto K, Einama T, Abe H, Suzuki T, Hamaguchi J, Kaga T, Sato M, Oomura M, Takata Y, Fujibe A, Takeda C, Tamura E, Taketomi A, Kyuno K. Accurate evaluation of axillary sentinel lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid in breast cancer: a preliminary clinical trial. SPRINGERPLUS 2015; 4:509. [PMID: 26405629 PMCID: PMC4573976 DOI: 10.1186/s40064-015-1291-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 11/13/2022]
Abstract
Breast cancer is the most common type of cancer in women. The 5-year survival rate in patients with breast cancer ranges from 74 to 82 %. Sentinel lymph node biopsy has become an alternative to axillary lymph node dissection for nodal staging. We evaluated the detection of the sentinel lymph node and metastasis of the lymph node using contrast enhanced ultrasonography with Sonazoid. Between December 2013 and May 2014, 32 patients with operable breast cancer were enrolled in this study. We evaluated the detection of axillary sentinel lymph nodes and the evaluation of axillary lymph nodes metastasis using contrast enhanced computed tomography, color Doppler ultrasonography and contrast enhanced ultrasonography with Sonazoid. All the sentinel lymph nodes were identified, and the sentinel lymph nodes detected by contrast enhanced ultrasonography with Sonazoid corresponded with those detected by computed tomography lymphography and indigo carmine method. The detection of metastasis based on contrast enhanced computed tomography were sensitivity 20.0 %, specificity 88.2 %, PPV 60.0 %, NPV 55.6 %, accuracy 56.3 %. Based on color Doppler ultrasonography, the results were sensitivity 36.4 %, specificity 95.2 %, PPV 80.0 %, NPV 74.1 %, accuracy 75.0 %. Based on contrast enhanced ultrasonography with Sonazoid, the results were sensitivity 81.8 %, specificity 95.2 %, PPV 90.0 %, NPV 90.9 %, accuracy 90.6 %. The results suggested that contrast enhanced ultrasonography with Sonazoid was the most accurate among the evaluations of these modalities. In the future, we believe that our method would take the place of conventional sentinel lymph node biopsy for an axillary staging method.
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Affiliation(s)
- Fumihiko Matsuzawa
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan ; Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo, Hokkaido 060-8638 Japan
| | - Kiyoka Omoto
- Diagnostic Ultrasound Division, Department of Laboratory Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503 Japan
| | - Takahiro Einama
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Hironori Abe
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Takashi Suzuki
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Jun Hamaguchi
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Terumi Kaga
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Mami Sato
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Masako Oomura
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Yumiko Takata
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Ayako Fujibe
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Chie Takeda
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Etsuya Tamura
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo, Hokkaido 060-8638 Japan
| | - Kenichi Kyuno
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
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28
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Zhang X, Jaffer S, Bleiweiss IJ, Nayak A. The clinical significance of internal mammary lymph node (IMLN) biopsy during autologous reconstruction in breast cancer patients. Breast Cancer Res Treat 2015; 153:565-72. [DOI: 10.1007/s10549-015-3569-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
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29
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Tallet A, Resbeut M. [Is there a rationale for regional node irradiation in pN1mi and pN0(i+) breast tumours?]. Cancer Radiother 2015; 19:284-7. [PMID: 26006762 DOI: 10.1016/j.canrad.2015.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
The advent of sentinel lymph node technique has led to a shift in lymph node staging, due to the emergence of new entities, namely micrometastases and isolated tumour cells. In addition, the therapeutic role of axillary lymph node dissection is more and more questioned and radiotherapy has been shown to be equivalent to complementary axillary lymph node dissection in patients without clinical node involvement. This article looks at the literature in favour of performing axillary irradiation in patients with pN1mi stage breast cancer who have undergone a mastectomy without a complementary axillary lymph node dissection, and in favour of abstention of any further treatment of the axilla in patients with pN0(i+) or pN1mi tumours who have undergone breast conserving surgery and a sentinel lymph node procedure followed by systemic treatment. The impact of regional lymph nodes irradiation in case of axillary involvement 2mm or less is also discussed.
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Affiliation(s)
- A Tallet
- Département d'oncologie-radiothérapie, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille cedex 09, France.
| | - M Resbeut
- Département d'oncologie-radiothérapie, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille cedex 09, France
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Arora D, Frakes J, Scott J, Opp D, Johnson C, Song J, Harris E. Incidental radiation to uninvolved internal mammary lymph nodes in breast cancer. Breast Cancer Res Treat 2015; 151:365-72. [DOI: 10.1007/s10549-015-3400-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/21/2015] [Indexed: 11/29/2022]
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Xue C, Peng RJ, Wang SS, Shi YX, An X, Xu F, Yuan ZY. Operable breast cancer of the inner hemisphere is associated with poor survival. J Breast Cancer 2015; 18:36-43. [PMID: 25834609 PMCID: PMC4381121 DOI: 10.4048/jbc.2015.18.1.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/05/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose This study investigated the clinicopathological features of operable breast cancer lesions located in different hemispheres of the breast and determined related survival outcomes. Methods Data from 5,330 patients with invasive ductal carcinoma were retrospectively analyzed based on tumor location. Results The median follow-up time was 68 months (range, 18-176 months). Patients with breast cancer located in the outer hemisphere of the breast had lesions with more advanced nodal stages and more frequently received adjuvant chemotherapy than patients with breast cancer in the inner hemisphere. The 5-year disease-free survival (DFS) rates of patients with tumors located in outer versus inner hemispheres were 81.5% and 77.0%, respectively (p=0.004); the overall survival (OS) rates were 90.7% and 88.8%, respectively (p<0.001). The association between tumor location and the 5-year DFS rate was most apparent in node-positive patients (73.1% vs. 65.8% for outer vs. inner hemisphere lesions, p<0.001) and in patients with primary tumors greater than 2 cm in diameter (78.2% vs. 72.3%, p=0.002). Multivariate analysis showed that tumor location was an independent predictor of DFS (hazard ratio [HR], 1.23; p=0.002) and OS (HR, 1.28; p=0.006). There were no significant differences in 5-year DFS or OS rates between patients with outer versus inner hemisphere tumors when internal mammary node irradiation was performed. Conclusion This study demonstrated that tumor location was an independent prognostic factor for operable breast cancer. Internal mammary node irradiation is recommended for patients with breast cancer of the inner hemisphere and positive axillary lymph nodes or large primary tumors.
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Affiliation(s)
- Cong Xue
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Rou Jun Peng
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Shu Sen Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Yan Xia Shi
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Xin An
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Fei Xu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Zhong Yu Yuan
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
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32
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Madsen EVE, Aalders KC, van der Heiden-van der Loo M, Gobardhan PD, van Oort PMP, van der Ent FW, Rutgers EJT, Valdés Olmes RA, Elias SG, van Dalen T. Prognostic Significance of Tumor-Positive Internal Mammary Sentinel Lymph Nodes in Breast Cancer: A Multicenter Cohort Study. Ann Surg Oncol 2015; 22:4254-62. [PMID: 25808100 DOI: 10.1245/s10434-015-4535-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The introduction of the sentinel lymph node biopsy (SLNB) in breast cancer has renewed interest in lymphatic drainage to the internal mammary (IM) nodes. The clinical impact of tumor positive IM nodes is not completely clear. This study evaluated the incidence and impact on overall survival of metastatic IM SLNs. METHODS Between 1997 and 2010, 3685 patients underwent surgery including SLNB for primary breast cancer following an intratumoral or peritumoral radioactive-tracer injection. The presence of lymph node metastases was categorized according to the TNM-classification. Cumulative overall survival was estimated and the influence of metastases in the IM nodes and other factors was assessed by Cox-regression-analysis. RESULTS In 754 patients (20.5 %) ipsilateral IM lymph nodes were visualized on preoperative lymphoscintigraphy, retrieval rate of IM SLNs was 81.0 %. IM metastases were detected in 130 patients (21.3 % of retrieved SLNs and 3.5 % of all patients respectively). The presence of IM metastases was associated with axillary metastases (p < 0.001). After a median follow-up of 61.2 months, 10.9 % of patients had died. In a multivariate analysis IM metastases did not have a significant effect on overall survival [HR] 1.20; CI: 0.73-1.98. In patients without axillary metastases (n = 2398), the presence of IM metastases (n = 43) was associated with worse survival [HR] 2.68; 95 % CI: 1.30-5.54. CONCLUSION Overall, the presence of IM metastases did not effect overall survival independent of other prognostic factors including axillary metastases. However, the small subgroup of patients who had IM metastases alone had worse outcome than patients without any regional lymph node metastases.
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Affiliation(s)
- Eva V E Madsen
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Kim C Aalders
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | | | | | | | | | - Emiel J T Rutgers
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Renato A Valdés Olmes
- Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Sjoerd G Elias
- Department of Clinical Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
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Stojanoski S, Ristevska N, Pop-Gjorcheva D, Antevski B, Petrushevska G. Internal Mammary Sentinel Lymph Nodes in Breast Cancer - Effects on Disease Prognosis and Therapeutic Protocols - A Case Report. Open Access Maced J Med Sci 2015; 3:139-42. [PMID: 27275211 PMCID: PMC4877773 DOI: 10.3889/oamjms.2015.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 02/06/2015] [Accepted: 02/07/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: The main prognostic factor in early staged breast cancer is the axillary lymph node metastatic affection. Sentinel lymph node biopsy, as a staging modality, significantly decreases surgical morbidity. The status of internal mammary lymph nodes gains an increased predictive role in grading breast carcinomas and modulation of postoperative therapeutic protocols. If positive, almost always are associated with worse disease outcome. Nevertheless, the clinical significance of internal mammary lymph node micrometastases has not been up to date precisely defined. AIM: To present a case of female patient clinically diagnosed as T1, N0, M0 (clinical TNM) ductal breast carcinoma with scintigraphic detection of internal mammary and axillary sentinel lymph nodes. METHODS: Dual method of scintigraphic sentinel lymph node detection using 99mTc-SENTI-SCINT and blue dye injection, intraoperative gamma probe detection, radioguided surgery and intraoperative ex tempore biopsy were used. CASE REPORT: We present a case of clinically T1, N0, M0 ductal breast cancer with scintigraphic detection of internal mammary and axillary sentinel lymph nodes. Intraoperative ex tempore biopsy revealed micrometastases in the internal mammary node and no metastatic involvement of the axillary sentinel lymph node. CONCLUSION: Detection of internal mammary lymph node metastases improves N (nodal) grading of breast cancer by selecting a high risk subgroup of patients that require adjuvant hormone therapy, chemotherapy and/or radiotherapy.
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Affiliation(s)
- Sinisa Stojanoski
- Institute of Patophysiology and Nuclear medicine "Acad Isak S. Tadzer", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Nevena Ristevska
- Institute of Patophysiology and Nuclear medicine "Acad Isak S. Tadzer", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Daniela Pop-Gjorcheva
- Institute of Patophysiology and Nuclear medicine "Acad Isak S. Tadzer", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Borce Antevski
- University Clinic of Thoraco-Vascular Surgery, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Gordana Petrushevska
- Institute of Pathology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Matsuzawa F, Einama T, Abe H, Suzuki T, Hamaguchi J, Kaga T, Sato M, Oomura M, Takata Y, Fujibe A, Takeda C, Tamura E, Taketomi A, Kyuno K. Accurate diagnosis of axillary lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid. Mol Clin Oncol 2014; 3:299-302. [PMID: 25798257 DOI: 10.3892/mco.2014.483] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/16/2014] [Indexed: 01/23/2023] Open
Abstract
Axillary lymph node enlargement following sentinel lymph node biopsy (SLNB) is often difficult to accurately diagnose. In keeping with the characteristically tortuous and aberrant pattern of tumor neovasculature, metastatic lymph nodes exhibit peripheral and mixed vascularity, resulting in a microvasculature that is often difficult to visualize. Contrast-enhanced ultrasonography (CEUS) with Sonazoid, a new generation contrast agent for ultrasonography, allows for the visualization of lymph node microvessels and may enable a more accurate evaluation of lymph node metastasis. This is a case report of axillary lymph node enlargement following SLNB, in which CEUS with Sonazoid resulted in an accurate diagnosis. On the basis of our experience with this case, we have initiated a clinical trial to evaluate the detection of lymph node metastasis through the use of CEUS in breast cancer patients.
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Affiliation(s)
| | - Takahiro Einama
- Departments of Surgery, Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Hironori Abe
- Departments of Surgery, Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Takashi Suzuki
- Departments of Surgery, Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Jun Hamaguchi
- Departments of Surgery, Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Terumi Kaga
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Mami Sato
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Masako Oomura
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Yumiko Takata
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Ayako Fujibe
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Chie Takeda
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Etsuya Tamura
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kenichi Kyuno
- Departments of Surgery, Obihiro Hospital, Obihiro, Hokkaido 080-0805
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Hennequin C, Fourquet A. Controverse sur l’irradiation de la chaîne mammaire interne dans le cancer du sein. Cancer Radiother 2014; 18:351-5. [DOI: 10.1016/j.canrad.2014.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 06/25/2014] [Indexed: 11/16/2022]
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Clinical Outcome of Reconstruction With Tissue Expanders for Patients With Breast Cancer and Mastectomy. Clin Breast Cancer 2014; 14:339-45. [DOI: 10.1016/j.clbc.2013.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/25/2013] [Accepted: 12/26/2013] [Indexed: 11/19/2022]
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Caudle AS, Yi M, Hoffman KE, Mittendorf EA, Babiera GV, Hwang RF, Meric-Bernstam F, Sahin AA, Hunt KK. Impact of identification of internal mammary sentinel lymph node metastasis in breast cancer patients. Ann Surg Oncol 2014; 21:60-5. [PMID: 24046126 DOI: 10.1245/s10434-013-3276-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Accurate assessment of the internal mammary (IM) nodal basin can impact prognosis and treatment in breast cancer. The goal of this study was to identify characteristics associated with positive IM sentinel lymph nodes (SLNs) and the impact on adjuvant treatment. METHODS Clinically node-negative breast cancer patients who underwent SLN dissection including removal of IM SLNs were identified and medical records were reviewed. Statistical analysis was performed using Fisher's exact test and rank-sum tests with a significance level of 0.05. RESULTS IM SLNs were removed in 71 patients, 60 (85 %) had negative IM SLNs, whereas 11 (15 %) had positive IM SLNs. Clinicopathologic characteristics were similar between the groups. The majority of patients in both groups had axillary SLNs removed (95 % in the node-negative group vs. 91 % in the node-positive group). Four patients (36 %) with positive IM SLNs had axillary metastasis; thus, IM nodal metastases were the only nodal metastases in 64 % of patients with positive IM SLNs. The identification of IM metastases altered adjuvant therapy in 5 (45 %) patients with positive IM SLNs. CONCLUSIONS Patients with positive IM SLNs have clinicopathologic features similar to those of patients with negative IM SLNs limiting the ability to predict IM nodal metastasis preoperatively. The identification of IM nodal metastases significantly impacts treatment decisions, especially when IM nodes are the only site of nodal metastasis. Removal of IM SLNs should be considered when lymphoscintigraphy reveals IM drainage.
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Affiliation(s)
- Abigail S Caudle
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
The notion that breast cancers can survive in an individual patient in a dormant state only to grow as metastatic disease in the future, is in our view incontrovertibly established. Convincing too is the evidence that surgery to remove the primary tumor often terminates dormancy resulting in accelerated relapses. Accepting that many deaths due to breast cancer might be averted were we to understand the cellular mechanisms underlying escape from dormancy, we have examined the extracellular signals produced by breast cancers derived from women with metastatic breast disease. In this perspective, we explore the role of extracellular nucleotide signaling that we have proposed constitutes a pathological axis from the transformed tumor cell to the endothelium in the service of intravasation, dissemination, extravasation and angiogenesis. A role for the dinucleotide kinase NM23/NDPK (nucleoside diphosphate kinase) secreted by breast tumor cells in the generation of signals that stimulate vascular leakiness, anti-thrombosis, endothelial migration and growth, constitutes a mechanistic basis for escape from latency and offers putative therapeutic targets for breast cancer management not previously appreciated.
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Impact of sentinel node biopsy on long-term quality of life in breast cancer patients. Br J Cancer 2013; 109:2783-91. [PMID: 24169352 PMCID: PMC3844912 DOI: 10.1038/bjc.2013.658] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/20/2013] [Accepted: 10/01/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study was to assess long-term quality of life (QoL) over a period of 6 years in women with breast cancer (BC) who underwent sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), or SLNB followed by ALND. METHODS The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ)-C30 and the EORTC-QLQ-BR-23 questionnaires were used to assess QoL before surgery, just after surgery, 6, 12 and 72 months later. The longitudinal effect of surgical modalities on QoL was assessed with a mixed model analysis of variance for repeated measurements. RESULTS Five hundred and eighteen BC patients were initially included. The median follow-up was 6 years. During the follow-up, 61 patients died. None of the patients of the SLNB group developed lymphedema during follow-up and the relapse rate was similar in the different groups (P=0.62). Before surgery, global health status (P=0.52) and arm symptoms (BRAS) (P=0.99) QoL scores were similar whatever the surgical procedure. The BRAS score (P=0.0001) was better in the SLNB group 72 months after surgery. Moreover, during follow-up, patients treated with SLNB had lower arm symptoms scores than ALND patients and there was no difference for arm symptoms between patients treated with ALND and those treated with SLNB followed by complementary ALND. CONCLUSION Long-term follow-up showed that SLNB was associated with less morbidity than ALND.
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Jagsi R. Postmastectomy radiation therapy: an overview for the practicing surgeon. ISRN SURGERY 2013; 2013:212979. [PMID: 24109522 PMCID: PMC3786459 DOI: 10.1155/2013/212979] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/24/2013] [Indexed: 12/21/2022]
Abstract
Locoregional control of breast cancer is the shared domain and responsibility of surgeons and radiation oncologists. Because surgeons are often the first providers to discuss locoregional control and recurrence risks with patients and because they serve in a key gatekeeping role as referring providers for radiation therapy, a sophisticated understanding of the evidence regarding radiotherapy in breast cancer management is essential for the practicing surgeon. This paper synthesizes the complex and evolving evidence regarding the role of radiation therapy after mastectomy. Although substantial evidence indicates that radiation therapy can reduce the risk of locoregional failure after mastectomy (with a relative reduction of risk of approximately two-thirds), debate persists regarding the specific subgroups who have sufficient risks of residual microscopic locoregional disease after mastectomy to warrant treatment with radiation. This paper reviews the evidence available to guide appropriate referral and patient decision making, with special attention to areas of controversy, including patients with limited nodal disease, those with large tumors but negative nodes, node-negative patients with high risk features, patients who have received systemic chemotherapy in the neoadjuvant setting, and patients who may wish to integrate radiation therapy with breast reconstruction surgery.
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Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, UHB2C490, SPC 5010, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5010, USA
- Center for Bioethics and Social Science in Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800, USA
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Hennequin C, Bossard N, Servagi-Vernat S, Maingon P, Dubois JB, Datchary J, Carrie C, Roullet B, Suchaud JP, Teissier E, Lucardi A, Gerard JP, Belot A, Iwaz J, Ecochard R, Romestaing P. Ten-Year Survival Results of a Randomized Trial of Irradiation of Internal Mammary Nodes After Mastectomy. Int J Radiat Oncol Biol Phys 2013; 86:860-6. [DOI: 10.1016/j.ijrobp.2013.03.021] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 02/22/2013] [Accepted: 03/15/2013] [Indexed: 10/26/2022]
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Choi JE. The Metastatic Rate of Internal Mammary Lymph Nodes When Metastasis of Internal Mammary Lymph Node Is Suspected on PET/CT. J Breast Cancer 2013; 16:202-7. [PMID: 23843854 PMCID: PMC3706867 DOI: 10.4048/jbc.2013.16.2.202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/24/2013] [Indexed: 01/24/2023] Open
Abstract
Purpose Metastatic status of internal mammary lymph node (IMLN) has a clinical importance in assessing the stage and prognosis of breast cancer. But, when metastasis of IMLN is suspected; the management is controversial. We retrospectively reviewed 36 breast cancer patients who underwent IMLN biopsy, and investigated the pathologic status of IMLN which suspected metastasis with positron emission tomography and computed tomography (PET/CT). Methods From January 2007 to December 2012, 36 patients underwent IMLN biopsy for suspected IMLN metastasis on PET/CT, when diagnosed with primary or recurrent breast cancer. Clinicopathologic features of these patients and metastatic status of IMLNs were investigated. Results A total of 36 patients were included in this study. Twenty-four patients diagnosed with primary breast cancer and 12 patients diagnosed with recurrent breast cancer underwent IMLN biopsy. The mean number of IMLNs was 2.72±2.05, and the total metastatic rate of IMLNs was 72.2% (26 out of 36). IMLN metastasis was confirmed on pathologic examination in 19 patients (79.2%, 19 out of 24) with primary breast cancer and in 7 patients (58.3%, 7 out of 12) with recurrent breast cancer. The mean standardized uptake values of metastatic and nonmetastatic IMLNs in primary breast cancer were 3.50±2.51 and 3.72±3.55, respectively and those of metastatic and nonmetastatic IMLN in recurrent breast cancer were 3.92±2.67 and 4.12±3.57, respectively. In both groups, there was no statistically significant difference between the SUVs of metastatic and nonmetastatic IMLNs (p=0.291 and p=0.951, respectively). Conclusion Due to the recent advances in diagnostic and surgical skills, IMLN biopsy can be performed safely without any complications without performing radical mastectomy. If IMLN metastasis is suspected on PET/CT, IMLN biopsy is useful to assess the exact stage and to determine the treatment for breast cancer. Further follow-up studies are needed to assess the locoregional recurrence and to compare the improvement in overall survival and disease-free survival.
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Affiliation(s)
- Jung Eun Choi
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
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Schaverien M, Purdie C, Munnoch D. Clinical value of internal mammary lymph node metastases found incidentally during free flap recipient vessel exposure. Eur J Surg Oncol 2013; 39:608-12. [DOI: 10.1016/j.ejso.2013.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/03/2013] [Accepted: 03/13/2013] [Indexed: 10/27/2022] Open
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Long H, Situ DR, Ma GW, Zheng Y. Thoracoscopic internal mammary lymph node dissection: a video demonstration. Ann Surg Oncol 2012. [PMID: 23208126 DOI: 10.1245/s10434-012-2751-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Internal mammary lymph node (IMN) metastasis in breast cancer is a well-established prognostic factor of similar importance to axillary lymph node status. Although randomized controlled trials in the 1970s failed to show a survival benefit of IMN dissection during extended radical mastectomy, they did demonstrate diminished survival of patients with IMN metastasis.1,2 The 2011 National Comprehensive Cancer Network Clinical Practice Guidelines recommend radiotherapy to the IMN chain that is clinically or pathologically positive. However, the direct contribution of IMN irradiation to improved survival is still controversial, while it may contribute to the increased risk of relevant cardiac mortality.3-5 METHODS Thoracoscopic internal mammary node dissection is a novel minimally invasive technique to assess and treat IMN metastasis. It ensures that the whole IMN chain is excised for histological evaluation, and therefore, no further irradiation of these regional nodes is needed. RESULTS This procedure is indicated in the following instances: operable invasive breast cancer; all medial or central tumors; lateral tumors with involved axillary lymph nodes; primary internal mammary lymphatic drainage detected by lymphoscintigraphy; and no contraindications to thoracoscopic surgery, including the inability to tolerate single-lung ventilation and extensive pleural adhesion. CONCLUSIONS Thoracoscopic internal mammary node dissection is a feasible procedure designed to provide simultaneous assessment and management of IMN metastasis. However, a larger study cohort with long-term follow-up is required to verify its safety and clinical significance.
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Affiliation(s)
- Hao Long
- Department of Thoracic Surgery, Cancer Center, Sun Yat-sen University, Guangzhou, China.
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Veronesi U, Stafyla V, Luini A, Veronesi P. Breast cancer: from "maximum tolerable" to "minimum effective" treatment. Front Oncol 2012; 2:125. [PMID: 23061042 PMCID: PMC3465814 DOI: 10.3389/fonc.2012.00125] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 09/09/2012] [Indexed: 11/27/2022] Open
Abstract
Randomized trials have played a fundamental role in identifying better treatments for most type of diseases, especially in the oncological field. In breast cancer, the shift from “maximum tolerable” to “minimum effective” treatment has been evident since the 1970s and has been based on the results of international randomized trials. The progress of breast surgery represents an excellent model of the evolution of science and the aim of this article is to review the main randomized studies that changed everyday practice in breast surgery.
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Affiliation(s)
- Umberto Veronesi
- Department of Senology, European Institute of Oncology Milan, Italy
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Besnard S, Cutuli B, Fourquet A, Giard S, Hennequin C, Leblanc-Onfroy M, Mazeau-Woynar V, Verdoni L. [Radiotherapy of invasive breast cancer: French national guidelines]. Cancer Radiother 2012; 16:503-13. [PMID: 22921978 DOI: 10.1016/j.canrad.2012.07.181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
The French National Cancer Institute (INCa) and Société française de sénologie et pathologie mammaire (SFSPM), in collaboration with a multidisciplinary experts group, have published the French national clinical practice guidelines on a selection of 11 currently debated questions regarding the management of invasive breast cancer. Those guidelines are based on a comprehensive analysis of the current published evidence dealing with those issues, secondly reviewed by 100 reviewers. Radiotherapy was concerned by five of the 11 questions: indications for the boost after whole gland irradiation; hypofractionated radiotherapy; partial breast irradiation; indications for mammary internal nodes irradiation, and indications of radiotherapy after neo-adjuvant chemotherapy.
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Affiliation(s)
- S Besnard
- Département recommandations et bon usage du médicament, direction des recommandations et de la qualité de l'expertise, Institut national du cancer, Boulogne-Billancourt, France.
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Affiliation(s)
- Kathryn T Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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