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The aim of this study was to evaluate the efficacy of bioimpedance spectroscopy for the follow-up of patients with lymphedema in Turkey and its benefits in the diagnosis of stage 0, 1, and 2 lymphedema in patients who are under treatment for breast cancer. Thirty-seven female patients with breast cancer who underwent surgical procedures in our Breast Health Centre were followed up for lymphedema using bioimpedance, and clinical measurements were taken for a minimum period of 1 year at 3-month intervals. Patients who had been monitored regularly between November, 2011, and September, 2013, were enrolled to the study. In total, 8 patients developed lymphedema with an overall rate of 21.6%. Among the 8 patients who developed lymphedema, 4 had Stage 2, 1 had Stage 1, and 3 had Stage 0 lymphedema. Stage 0 lymphedema could not be detected with clinical measurements. During the patients' 1-year follow-up period using measurements of bioimpedance, a statistically significant relationship was observed between the occurrence of lymphedema and the disease characteristics. including the number of the extracted and remaining lymph nodes and the region of radiotherapy (p=0.042, p=0.024, p=0.040). Bioimpedance analysis seems to be a practical and reliable method for the early diagnosis of lymphedema. It is believed that regular monitoring of patients in the high-risk group using bioimpedance analyses increases the ability to treat lymphedema.

ABSTRACT. The aim of this study is to evaluate the coverage of axillary nodal volumes with high tangent fields (HTF) in breast radiotherapy and to determine the utility of customised blocking. The treatment plans of 30 consecutive patients with early breast cancer were evaluated. The prescription dose was 50 Gy to the whole breast. Axillary level I-II lymph node volumes were delineated and the cranial border of the tangential fields was set just below the humeral head to create HTF. Dose-volume histograms (DVH) were used to calculate the doses received by axillary nodal volumes. In a second planning set, HTF were modified with multileaf collimators (MLC-HTF) to obtain an adequate dose coverage of axillary nodes. The mean doses of the axillary nodes, the ipsilateral lung and heart were compared between the two plans (HTF vs MLC-HTF) using a paired sample t-test. The doses received by 95% of the breast volumes were not significantly different for the two plans. The doses received by 95% of the level I and II axillary volumes were 16.79 Gy and 11.59 Gy, respectively, for HTF, increasing to 47.2 Gy and 45.03 Gy, respectively, for MLC-HTF. Mean lung doses and per cent volume of the ipsilateral lung receiving 20 Gy (V20) were also increased from 6.47 Gy and 10.47%, respectively, for HTF, to 9.56 Gy and 16.77%, respectively, for MLC-HTF. Our results suggest that HTF do not adequately cover the level I and II axillary lymph node regions. Modification of HTF with MLC is necessary to obtain an adequate coverage of axillary levels without compromising healthy tissue in the majority of the patients. Sentinel lymph node (SLN) biopsy for clinically nodenegative breast cancer has become the standard approach for the surgical evaluation of the axilla [1,2]. If the final pathology report reveals metastatic involvement of the sentinel lymph node(s), then axillary lymph node dissection (ALND) is considered. Irradiation of the axillary lymph nodes is also an option for regional treatment. Axillary radiation and surgery have provided equivalent local control in early breast cancer patients [3,4]. Randomised trials to evaluate the efficacy and toxicity of surgical or radiotherapeutic management of axilla with positive sentinel lymph node biopsy have been planned, and the results are pending [5]. Irradiation of the axilla can be performed via separate anteriorposterior fields; alternatively a portion of the axilla (the most likely levels I and II) can be covered by the tangential fields; Irradiating the lower levels of the axilla through tangential fields is considered to be more practical. In the era of CT-based three dimensional (3D) radiotherapy planning, however, concerns have been raised about the adequacy of coverage of the axillary levels in the tangential fields [6][7][8][9][10].In this study, we evaluated the coverage of the axillary nodal levels administered using modified high tangential fields in patients without axillary dissection and the effect of this modification on the doses received by the ipsilateral lung. Methods ...