1
|
Wang W, Sun T, Meng Y, Xu M, Zhang Y, Shao Q, Song Y, Li J. Dosimetric Evaluation of Incidental Irradiation to the Internal Mammary Chain After Surgery in Breast Cancer Patients. Front Oncol 2022; 12:839831. [PMID: 35311065 PMCID: PMC8928457 DOI: 10.3389/fonc.2022.839831] [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: 12/20/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose The low rate of internal mammary node (IMN) recurrence was attributed to systemic therapy and internal mammary chain (IMC) coverage by the tangential fields of irradiation. This study aimed to evaluate the incidental irradiation dose to the IMC in breast cancer patients after surgery and to estimate the clinical predictive parameters affecting the magnitude of the IMC. Materials and Methods A total of 138 patients treated with postmastectomy radiotherapy and 210 patients undergoing radiotherapy after breast-conserving surgery (BCS) in our hospital were retrospectively analyzed. The mean dose (Dmean) to the IMC and the first to third intercostal spaces of IMC levels (ICS1–3) were evaluated. We evaluated the IMC coverage according to the type of surgery and whether the ipsilateral supraclavicular fossa (SCF) was included in the irradiation field. Results The incidental radiation dose to the IMC was 29.69 Gy, and the dose delivered to the IMC, ICS1, and ICS2 showed a greater coverage in the modified radical mastectomy (MRM) group when compared with the BCS group (32.85 vs. 27.1 Gy, 26.6 vs. 12.5 Gy, 34.63 vs. 30.42 Gy). The dose delivered to ICS3 showed no difference between the MRM and BCS groups (37.41 vs. 36.24 Gy). Furthermore, 131 patients (37.64%) received radiotherapy to the chest wall and ipsilateral SCF. In the univariate analysis, both surgery type and SCF irradiation were parameters affecting the Dmean of incidental radiation to the IMC (r = −0.179, P = 0.001; r = −0.175, P = 0.001). In the multivariate analysis, surgery type was the only correlative factor that affected incidental radiation dose to the IMC (r = –3.534, P = 0.000). Conclusion The real influencing factor of incidental dose to the IMC was the surgery form rather than the accession of SCF irradiation.
Collapse
Affiliation(s)
- Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tao Sun
- Department of Medical Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingtao Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yuanfang Song
- Department of Radiation Oncology, Wei Hai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| |
Collapse
|
2
|
Kim SW, Chun M, Oh YT, Noh OK. Loco-regional outcomes of adjusted breast radiotherapy with conventional fractionation after breast conserving surgery: De-escalation of whole breast irradiation dose. Medicine (Baltimore) 2020; 99:e19916. [PMID: 32358358 PMCID: PMC7440294 DOI: 10.1097/md.0000000000019916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We compared the cumulative incidence of ipsilateral breast tumor recurrence (IBTR) between 2 whole breast irradiation (WBI) dose range with conventional fractionation.We retrospectively reviewed 1122 patients who received WBI at 2 institutions between 2004 and 2012. One institution delivered WBI 41.4 to 45 Gy followed by boost 14 to 18 Gy (adjusted group), while the other delivered WBI 50 to 50.4 Gy followed by boost 10 Gy (standard group).The median follow-up period was 85 months. The 10-year cumulative incidence in all patients was 6.1% (95% confidence interval [CI]: 4.3%-8.4%) for IBTR and 3.0% (95% CI: 1.7%-4.8%) for regional recurrence. The 10-year cumulative incidence of IBTR was not significantly influenced by WBI dose (6.3% in the adjusted group vs 5.2% in the standard group, P = .136). Comparable IBTR rates between the 2 groups were observed regardless of clinical and pathological factors. The WBI dose was not significantly associated with the 10-year cumulative incidence of regional recurrence in these groups (3.5% in the adjusted group vs 0.5% in the standard group, P = .214).De-escalated WBI doses while intensifying tumor bed boost did not compromise local and regional outcomes compared to standard group.
Collapse
Affiliation(s)
- Sang-Won Kim
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon
- Department of Radiation Oncology, Myunggok Medical Research Institute, Konyang University College of Medicine, Daejeon
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon
| | - O. Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon
- Department of Bioinformatics, Ajou University School of Medicine, Suwon, Republic of Korea
| |
Collapse
|
3
|
Wang W, Wang J, Qiu P, Sun T, Zhang Y, Shao Q, Xu M, Liu X, Li J. Factors Influencing the Incidental Dose Distribution in Internal Mammary Nodes: A Comparative Study. Front Oncol 2020; 10:456. [PMID: 32328459 PMCID: PMC7160365 DOI: 10.3389/fonc.2020.00456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/13/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the effect of anatomic and technical parameters on the incidental internal mammary lymph node (IMN) irradiation (IIMNI) dose among postmastectomy patients. Methods: We retrospectively delineated the IMN on planning CT images from 138 patients who had undergone postmastectomy radiotherapy (PMRT). We analyzed the IIMNI dose coverage and its relationship with anatomic and technical parameters. Results: The IIMNI mean dose was 32.85 ± 9.49 Gy, and 10 of 138 patients (7.25%) treated with PMRT received ≥45 Gy. In univariate analysis, the body weight, body mass index, body surface area, thoracic transverse diameter (DT), ratio of DT to the thoracic anteroposterior diameter (DAP)(RT/AP), planning target volume of IMN (PTVIMN) included in PTV (IMNin) and the ratio of IMNin to PTVIMN (RIMNin) and PTV posterior border were the parameters affecting IIMNI dose. In multivariate analysis, body weight, RT/AP, and RIMNin were correlative factors that affected IIMNI dose. Conclusions: For patients who underwent PMRT without IMN irradiation (IMNI), there was a wide variety in IIMNI doses. A minority of patients had adequate IIMNI dose coverage, and the higher IIMNI doses were associated with the less body weights and more RIMNin.
Collapse
Affiliation(s)
- Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinzhi Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Pengfei Qiu
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tao Sun
- Department of Medical Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xijun Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| |
Collapse
|
4
|
Xie X, Xiong Z, Li X, Huang X, Ye F, Tang H, Xie X. Nomogram to Predict Internal Mammary Lymph Nodes Metastasis in Patients With Breast Cancer. Front Oncol 2019; 9:1193. [PMID: 31781496 PMCID: PMC6857087 DOI: 10.3389/fonc.2019.01193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 10/21/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Numerous studies have showed that internal mammary lymph node (IMLN) metastasis is an important adverse prognostic factor in patients with breast cancer (BC), however, there are no available prediction model for the preoperative diagnosis of IMLN metastasis. Methods: Data from 102 breast cancer patients treated with IMLN operation were used to establish and calibrate a nomogram for IMLN status based on multivariate logistic regression. Prediction performance of this model was further validated with a second set of 50 patients with BC. Discrimination of the predict model was assessed by the C-index, and calibration assessed by calibration plots. Moreover, we conducted the decision curve analysis (DCA) to evaluate the clinical value of the nomogram. Finally, the survival status of patients in different risk groups based on nomogram were also compared. Results: The final multivariate regression model included tumor location, lymph vascular invasion (LVI), and pathological axillary lymph node stage (pALN stage). A nomogram was developed as a graphical representation of the model and had good calibration and discrimination in both sets (with C-index of 0.86 and 0.83 for the training and validation set, respectively). Moreover, the DCA showed the clinical usefulness of our constructed nomogram. False negative (FN) in low risk group classified by nomogram (FN-LR-nomogram) did not significantly impact adjuvant treatment decision making, and more importantly, patients with FN-LR-nomogram had recurrence-free survival equivalent to patients with pathologically ture negative in low risk group classified by nomogram (TN-LR-nomogram). Conclusions: As a non-invasive prediction tool, our nomogram shows favorable predictive accuracy for IMLN metastasis in patients with BC and can serve as a basis to integrate future molecular markers for its clinical application.
Collapse
Affiliation(s)
- Xinhua Xie
- Laboratory of Oncology in South China, Department of Breast Oncology, State Key Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhenchong Xiong
- Laboratory of Oncology in South China, Department of Breast Oncology, State Key Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xing Li
- Laboratory of Oncology in South China, Department of Breast Oncology, State Key Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaojia Huang
- Laboratory of Oncology in South China, Department of Breast Oncology, State Key Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Feng Ye
- Laboratory of Oncology in South China, Department of Breast Oncology, State Key Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hailin Tang
- Laboratory of Oncology in South China, Department of Breast Oncology, State Key Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaoming Xie
- Laboratory of Oncology in South China, Department of Breast Oncology, State Key Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
5
|
Song Y, Yu T, Wang W, Li J, Sun T, Qiu P, Xu M, Shao Q. Dosimetric comparison of incidental radiation to the internal mammary nodes after breast-conserving surgery using 3 techniques-inverse intensity-modulated radiotherapy, field-in-field intensity-modulated radiotherapy, and 3-dimensional conformal radiotherapy: A retrospective clinical study. Medicine (Baltimore) 2019; 98:e17549. [PMID: 31593136 PMCID: PMC6799772 DOI: 10.1097/md.0000000000017549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The study aimed to evaluate and compare the dosimetric parameters of incidental irradiation to internal mammary node (IMN) from inverse intensity-modulated radiotherapy (I-IMRT) and field-in-field IMRT (F-IMRT), and 3-dimensional conformal radiotherapy (3D-CRT) in patients after breast-conservation surgery (BCS). METHODS Eighty-four patients with BCS were selected. The breast, tumor bed, and IMN, including intercostal spaces (ICS) 1 to 3, were contoured. Three plans were generated. The prescription doses for the breast and tumor bed were 50.4 Gy/28 F and 60.2 Gy/28 F, respectively. If there was no tumor bed boost, patient was treated with 50 Gy/25 F for the whole breast only. The IMN was not included in planning target volume. RESULTS The median mean dose (Dmean) of the IMNtotal (ICS 1-3) was 2740.2 cGy, 2973.9 cGy, and 2951.4 cGy for I-IMRT, F-IMRT, and 3D-CRT, respectively. Differences were not detected between any of the plans. After separating ICS 1 to 3 for further analysis, neither of the Dmean of ICS 1 to 2 was significantly different between the plans. However, for ICS 3, the median Dmean was highest for I-IMRT, and those for 3D-CRT and F-IMRT were not significantly different. After separating the 3 techniques for further analysis, the median Dmean was highest in ICS 3 and lowest in ICS 1 for all the 3 techniques. CONCLUSION All 3 techniques failed to attain an adequate dose to cure subclinical disease, and there were no significant differences among the 3 techniques. It is risky to avoid IMN irradiation (IMNI) using any of the 3 techniques during whole-breast radiotherapy in women with indications for elective IMNI. However, in era of systematic therapy, whether the incidental dose could meet clinical acquirements needs further follow-up.
Collapse
Affiliation(s)
- Yuanfang Song
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Ting Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
- Tianjin Medical University, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Tao Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Pengfei Qiu
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| |
Collapse
|
6
|
Borm KJ, Oechsner M, Düsberg M, Buschner G, Weber W, Combs SE, Duma MN. Irradiation of regional lymph node areas in breast cancer - Dose evaluation according to the Z0011, AMAROS, EORTC 10981-22023 and MA-20 field design. Radiother Oncol 2019; 142:195-201. [PMID: 31540747 DOI: 10.1016/j.radonc.2019.08.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/07/2019] [Accepted: 08/24/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate the dose distribution from randomized trials (MA.20, EORTC 22922-10925 (EORTC), AMAROS and the Z0011 trial) on lymph node (LN) irradiation on a large LN atlas. METHODS 580 F18-FDG-PET/CT positive LN metastases of 235 patients were transferred rigidly and non-rigidly to three "template CTs" (standard, obese and slender patient). Further, the LN clinical target volumes (CTVs) were contoured according to the ESTRO-guidelines. Treatment plans were designed (each for the left and right side) for all patients based on the study protocols of the MA.20, EORTC, AMAROS and Z0011 trial. Subsequently, the dose distribution in the ESTRO-CTVs and in the 580 LNs were assessed. RESULTS Our results reveal variable dose coverage (26.8 ± 17.3 Gy-53.0 ± 1.8 Gy) in the targeted LN areas (ESTRO-CTV and LN) in dependence of the treatment planning design and the patients' body shape. None of the treatment plan designs provided full dose coverage to the lymphatic drainage system. High tangent irradiation resulted in a similar dose distribution in L I and II compared to the AMAROS field design. CONCLUSION Inclusion of the entire lymphatic system may not be necessary for all patients to reproduce the oncologic benefit shown in the randomized LN-irradiation trials. Inclusion of axillary level II and extension of the supraclavicular CTV can be considered in selected high-risk patients, based on dose recalculation of the MA.20 trial. Further, our results amplify earlier assumptions that irradiation may have accounted for the good results after SLND alone in the Z0011 trial.
Collapse
Affiliation(s)
- Kai Joachim Borm
- Technical University Munich, Medical School, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Germany.
| | - Markus Oechsner
- Technical University Munich, Medical School, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Germany.
| | - Mathias Düsberg
- Technical University Munich, Medical School, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Germany.
| | - Gabriel Buschner
- Technical University Munich, Medical School, Klinikum rechts der Isar, Department of Nuclear Medicine, Technical University of Munich (TUM), Germany.
| | - Wolfgang Weber
- Technical University Munich, Medical School, Klinikum rechts der Isar, Department of Nuclear Medicine, Technical University of Munich (TUM), Germany.
| | - Stephanie Elisabeth Combs
- Technical University Munich, Medical School, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Germany; Deutsches Konsortium für Translationale Krebsforschung (DKTK)-Partner Site Munich, Germany; Institute of Radiation Medicine, Helmholtzzentrum München, Neuherberg, Germany.
| | - Marciana-Nona Duma
- Technical University Munich, Medical School, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Germany; Department of Radiotherapy and Radiation Oncology, Friedrich Schiller University Hospital, Jena, Germany.
| |
Collapse
|
7
|
Loganadane G, Kassick M, Kann BH, Young MR, Knowlton CA, Evans SB, Higgins SA, Belkacemi Y, Potenziani M, Saltmarsh N, Wilson LD, Moran MS. Standard Tangential Radiation Fields Do Not Provide Incidental Coverage to the Internal Mammary Nodes. Pract Radiat Oncol 2019; 10:21-28. [PMID: 31394256 DOI: 10.1016/j.prro.2019.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/03/2019] [Accepted: 07/23/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the incidental dose delivered to the internal mammary nodes (IMNs) in patients treated with tangential 3-dimensional conformal radiation therapy and to identify potential parameters that may affect the IMN mean dose. METHODS AND MATERIALS The study cohort consisted of 362 consecutively treated patients with breast cancer in our center between January 2015 and July 2017 who had received adjuvant whole-breast radiation therapy or postmastectomy radiation with or without a supraclavicular ± axillary field and without intentional inclusion of the IMN chain. The clinical target volume (CTV) for the IMNs was contoured per the Radiation Therapy Oncology Group 3509/3510 protocol and was then divided into 3 subregions: upper, mid, and lower thirds. The planning target volume for the IMNs was generated by adding 5 mm to the CTV. The primary endpoint was to assess the V40 (volume receiving 40 Gy) to the IMN planning target volume and its potential influencing parameters using a linear regression model. RESULTS The mean (±standard deviation) dose to the CTV IMN chain was 36% ± 28.7%. The Kruskal-Wallis test demonstrated significant differences in the median dose delivered to each level: upper third (7.2%), mid third (21.5%), and lower third (41.7%) (P < .001). The mean V40 IMN planning target volume was 14.2% (standard deviation, 18.7%). Presternal fat thickness (regression coefficient [RC] = -16.4; P < .001), postmastectomy radiation (RC = 24; P < .001), reconstruction after mastectomy (RC = -22.4; P < .001), and the addition of a supraclavicular field (RC = 8.8; P = .03) were all significantly associated with IMN mean dose. CONCLUSIONS For patients receiving standard breast/chest wall tangential radiation fields, the IMN chain is not incidentally covered with therapeutic doses in the vast majority of cases. Therefore, if regional nodal radiation is intended to include the IMNs, contouring and careful plan review are necessary to ensure adequate therapeutic coverage.
Collapse
Affiliation(s)
- Gokoulakrichenane Loganadane
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Department of Radiation Oncology, Assistance publique-Hôpitaux de Paris, University of Paris-Est Créteil and Henri Mondor Breast Center, Créteil Cedex, France
| | - Megan Kassick
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin H Kann
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Melissa R Young
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Christin A Knowlton
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Suzanne B Evans
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Susan A Higgins
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Yazid Belkacemi
- Department of Radiation Oncology, Assistance publique-Hôpitaux de Paris, University of Paris-Est Créteil and Henri Mondor Breast Center, Créteil Cedex, France
| | - Mary Potenziani
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Nicholas Saltmarsh
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
| |
Collapse
|
8
|
Incidental Dose to Ipsilateral and Contralateral Internal Mammary Chain by Partial Tangential Arc Technique: A Single Institutional Analysis in Breast Cancer Patients. Clin Oncol (R Coll Radiol) 2019; 31:401. [PMID: 30782445 DOI: 10.1016/j.clon.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/23/2019] [Accepted: 02/01/2019] [Indexed: 11/20/2022]
|
9
|
Wang W, Zhang Y, Xu M, Shao Q, Sun T, Yu T, Liu X, Li J. Postmastectomy radiotherapy using three different techniques: a retrospective evaluation of the incidental dose distribution in the internal mammary nodes. Cancer Manag Res 2019; 11:1097-1106. [PMID: 30774438 PMCID: PMC6361227 DOI: 10.2147/cmar.s191047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective To evaluate the incidental coverage dose to the internal mammary nodes (IMN) in patients treated with postmastectomy radiotherapy (PMRT) and its relationship with the treatment plan. Patients and methods We retrospectively analyzed 138 patients undergoing PMRT and divided them into three groups: three-dimensional conformal radiotherapy (3D-CRT), field-in-field forward intensity-modulated radiotherapy (F-IMRT), and inverse intensity-modulated radiotherapy (I-IMRT). The IMN were contoured according to the Radiation Therapy Oncology Group consensus and not included in the planning target volume. We analyzed incidental IMN dose coverage and its relationship with the lung and heart. Results The mean dose (Dmean) to the IMN was 32.85 Gy for all patients, and the dose delivered to the IMN showed no differences in 3D-CRT, F-IMRT, and I-IMRT (33.80, 29.65, and 32.95 Gy, respectively). In addition, 10.42%, 2.04%, and 9.76% of patients achieved ≥45 Gy with 3D-CRT, F-IMRT, and I-IMRT, respectively. No differences were evident among the three treatment plans regarding IMN dose in the first three intercostal spaces (ICS1-3). The Dmean, V20, V30, V40, and V50 of ICS2 and ICS3 were superior to those of ICS1 for all three plans. For 3D-CRT, a moderate positive correlation was evident between the Dmean to the IMN and the Dmean to the heart. For F-IMRT and I-IMRT, positive correlations were evident between the Dmean of the IMN and the Dmean and V20 of the lung. Conclusion The mean incidental dose to the IMN for IMRT (F-IMRT and I-IMRT) and 3D-CRT after modified radical mastectomy was insufficient to treat subclinical disease. A substantial dose was delivered to the IMN in some patients. Higher incidental doses to the IMN were associated with a higher heart mean dose for 3D-CRT and a higher dose to the lung for IMRT. Future prospective studies should further explore subgroups that do not require IMN irradiation.
Collapse
Affiliation(s)
- Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong 250117, China,
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong 250117, China,
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong 250117, China,
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong 250117, China,
| | - Tao Sun
- Department of Medical Physics, Shandong Cancer Hospital affiliated with Shandong University, Jinan, Shandong 250117, China
| | - Ting Yu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong 250117, China, .,School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China
| | - Xijun Liu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong 250117, China,
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong 250117, China,
| |
Collapse
|
10
|
Abdel-Rahman O. Impact of Regional Nodal Irradiation on the Outcomes of N1 Breast Cancer Patients Referred for Adjuvant Treatment: A Patient-Level Pooled Analysis of 2 Clinical Trials. Clin Breast Cancer 2018; 18:504-510. [PMID: 30115454 DOI: 10.1016/j.clbc.2018.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/03/2018] [Accepted: 07/16/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate the impact of regional nodal irradiation (RNI) among N1 operable breast cancer patients who underwent adequate axillary dissection and received adjuvant chemotherapy. PATIENTS AND METHODS This is a pooled analysis of 812 breast cancer patients referred for adjuvant systemic therapy in 2 prospective randomized studies: NCT00174655 (BIG 02/98) and NCT00312208 (BCIRG005). Overall survival was assessed according to whether patients received supraclavicular and/or internal mammary radiotherapy through Kaplan-Meier estimates. Univariate and multivariate analyses of variables affecting overall and relapse-free survival were performed through Cox regression analysis. Additionally, recurrence rates were analyzed according to regional irradiation patterns. RESULTS Regional relapse rates (after a median follow-up of 76 months) were 1.5% in both groups of patients who received or did not receive supraclavicular radiotherapy. The risk of regional recurrence was 0.7% in patients who received internal mammary node radiotherapy versus 1.6% in patients who did not receive internal mammary node radiotherapy. The following factors were associated with worse overall survival in multivariate Cox regression analysis: age < 40 years (P < .0001), > T1 stage (P = .003), and negative hormone receptor status (P = .002). Neither supraclavicular nor internal mammary radiotherapy was associated with improvement in overall or relapse-free survival in Cox regression analysis. CONCLUSION The current analysis does not endorse the routine use of supraclavicular or internal mammary radiotherapy among N1 operable breast cancer patients who have undergone adequate dissection of axillary lymph nodes and who have received standard adjuvant systemic therapy. Given the limited power and potential selection bias of the current analysis, further prospective studies are needed to tackle this research question.
Collapse
Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
| |
Collapse
|
11
|
Qingqing H, Jian Z, Dayong Z, Ziyi F, Luming Z, Peng Z, Fang Y, Gaofeng N, Xuefeng D, Meng W, Dan W, Lei H, Xiaolei L, Tao Y. Robot-Assisted Internal Mammary Lymph Node Chain Dissection for Breast Cancer. Clin Breast Cancer 2018; 18:e441-e445. [PMID: 29752223 DOI: 10.1016/j.clbc.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/07/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
Affiliation(s)
- He Qingqing
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China.
| | - Zhu Jian
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Zhuang Dayong
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Fan Ziyi
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Zheng Luming
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Zhou Peng
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Yu Fang
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Ni Gaofeng
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Dong Xuefeng
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Wang Meng
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Wang Dan
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Hou Lei
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Li Xiaolei
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| | - Yue Tao
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, China
| |
Collapse
|