Axillary Coverage by Whole Breast Irradiation in 1 to 2 Positive Sentinel Lymph Nodes in Breast Cancer Patients

Santis, M.C. De; Bonfantini, F.; Dispinzieri, M.; Meroni, Silvia; Diletto, B.; Mantero, E; Franceschini, Marzia; Soncini, F.; Cosimo, Serena Di; Cosentino, V.; Pignoli, E.; Lozza, Laura

doi:10.5301/tj.5000482

Cited by 7 publications

(8 citation statements)

References 25 publications

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“…All of these conditions were investigated comparing VMAT against several photon based techniques. In particular, the role of VMAT when nodal irradiation is required was investigated by [ 22 , 24 , 52 – 55 , 59 , 63 , 67 , 75 , 77 ]. The post-mastectomy situation was studied by [ 26 , 45 , 49 , 59 , 62 , 64 , 69 , 71 , 75 , 76 ].…”

Section: Resultsmentioning

confidence: 99%

Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

et al. 2017

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Background: The aim of this review is the critical appraisal of the current use of volumetric modulated arc therapy for the radiation therapy management of breast cancer. Both clinical and treatment planning studies were investigated. Material and methods: A Pubmed/MEDLINE search of the National Library of Medicine was performed to identify VMAT and breast related articles. After a first order rejection of the irrelevant findings, the remaining articles were grouped according to two main categories: clinical vs. planning studies and to some sub-categories (pointing to significant technical features). Main areas of application, dosimetric and clinical findings as well as areas of innovations were defined.

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Section: Resultsmentioning

confidence: 99%

Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

et al. 2017

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“… 15 A volumetric study of 10 patients with breast cancer with 3 types of plans created for each case found the median V95 of level I LNs to be 26.4% for 3-dimensional plans, 8.6% for static intensity modulated radiation therapy plans, and 2.6% for volumetric modulated arc therapy plans. 14 Although this is a small study, the implication is that the more conformal the treatment plan is to the breast, the less the volume of nodal coverage.…”

Section: Discussionmentioning

confidence: 93%

“…A CT-based retrospective evaluation of nodal coverage in tangential fields found that adequate coverage, defined as 95% of the volume receiving 95% of the dose, was achieved in none of the patients with standard tangential fields. 14 A prospective study of SLN coverage, using clips to identify the SLN biopsy site, showed a mean dose to the SLN of 29 Gy for a standard tangent field and 28 Gy with a high tangential field. 15 A volumetric study of 10 patients with breast cancer with 3 types of plans created for each case found the median V95 of level I LNs to be 26.4% for 3-dimensional plans, 8.6% for static intensity modulated radiation therapy plans, and 2.6% for volumetric modulated arc therapy plans.…”

Section: Discussionmentioning

confidence: 99%

“…This concept is supported by our data. 14 The Z0011 trial raises the question of optimal treatment of LNs in SLN-positive breast cancer. The explanation of nodal coverage by tangential radiation fields is not sufficient because multiple studies demonstrate incomplete nodal coverage, and the modern trend of more conformal therapy reduces LN coverage in tangential fields.…”

Section: Discussionmentioning

confidence: 99%

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Axillary lymph node coverage with 3-dimensional tangential field irradiation and correlation with heart and lung dose

Jacobson

Bunda-Randall

Wen

et al. 2017

Advances in Radiation Oncology

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PurposeThe American College of Surgeons Oncology Group Z0011 trial indicated no benefit from axillary lymph node (LN) dissection after a positive sentinel LN biopsy in patients receiving breast irradiation, suggesting that level I-II LNs were covered in tangential fields.Methods and materialsWe evaluated 50 computed tomography–based tangential breast plans and contoured level I-III axillary LNs using the Radiation Therapy Oncology Group guidelines. The volumes of level I-III LN regions covered by 90% and 95% of the prescription dose (PD) were calculated and correlated with the V20 ipsilateral lung and mean heart dose. We calculated field length, distance from the humeral head, and separation. The Pearson correlation method and linear models were used in the correlative study.ResultsLevel I LN mean and median volume (MMV) covered by 90% of the PD were 46.8% and 47.2%, respectively. MMV covered by 95% of the PD was 30.8% and 29.62%. Mean and median dose to level I LNs were 29.03 Gy and 30.13 Gy, respectively. The MMV of level II LNs covered by 90% of the PD was 2.49% and 0%. The mean and median dose to level II LNs were 6.09 Gy and 2.12 Gy, respectively. The MMV of level III LNs was 0% with a mean and median dose of 1.04 Gy and 0.92 Gy, respectively. There was a moderate correlation between the 95% prescription coverage of level I LNs and V20 ipsilateral lung and a smaller correlation between 95% prescription coverage of level I LNs and mean heart dose. Distance from the humeral head was inversely correlated with coverage of level I and II LNs and positively correlated with V20 lung.ConclusionIn most patients, <50% of the level I LN volume was covered by 90% of the PD and <30% was covered by 95%; <5% of the level II nodes were covered by 90% of the PD; and coverage was 0% for level III LNs.

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“…Even with 3D CT-planning techniques, the 95% isodose line still has been found to encompass 55% of the axillary levels 1 and 2 lymph node anatomic volume, 18 and it has been hypothesized that for 76% of patients, the site of the SLN received an elective radiation dose. 19 However, in the current era, radiation techniques have improved further, with such procedures as intensity-modulated radiotherapy (IMRT), volumetric modulated-arc therapy (VMAT), 20 and protontherapy, resulting in even more conformal dose distributions around strictly defined target volumes. 21 These techniques reduce any accidental dose to the axillary nodes considerably and are expected to reduce side effects due to lower doses to healthy tissues.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the Mitigating Effects of Whole-Breast Radiotherapy and Systemic Treatments on Regional Recurrence Incidence Among Breast Cancer Patients

et al. 2020

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Background. Despite the potential for residual lymph node metastases after a negative or positive sentinel lymph node biopsy (SLNB), breast cancer patients rarely experience regional recurrences (RRs). This study aimed to quantify the effects of nonsurgical treatments on RR incidence among SLNB-negative (SLNB N0) breast cancer patients. Methods. All primary SLNB N0-staged breast cancer patients with a diagnosis between 2005 and 2008 and 5-year follow-up data on recurrences were selected from the Netherlands Cancer Registry. The cumulative incidence function (CIF) for RR was calculated as the first event at 5 years, taking into account any other first-event (local or distant recurrence, contralateral breast cancer, or death) as competing risk. Cox regression analysis was used to model the cause-specific hazard of RR developing as the first event to quantify the effect of adjuvant systemic therapy and whole-breast radiotherapy (RT) on RR incidence at 5 years. Results. The study included 13,512 patients. Of these patients, 162 experienced an RR. The CIF of RR at 5 years was 1.3% (95% confidence interval [CI], 1.1-1.5%), whereas the CIFs for death and other events were 4.4% and 9.5%, respectively. Cox regression analysis showed hazard ratios (HRs) of 0.46 (95% CI 0.33-0.64), 0.31 (95% CI 0.18-0.55), and 0.40 (95% CI 0.24-0.67) respectively for patients treated by RT as a routine part of breast-conserving therapy (BCT), chemotherapy, and hormonal therapy. Conclusion. RT as routine part of BCT, chemotherapy, and hormonal therapy independently exerted a mitigating effect on the risk for the development of RR. The three methods at least halved the risk.

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Axillary Coverage by Whole Breast Irradiation in 1 to 2 Positive Sentinel Lymph Nodes in Breast Cancer Patients

Abstract: Results of our analysis showed that standard 3D tangential whole breast irradiation failed to deliver a therapeutic dose to axillary levels I and II. The coverage was even lower using static and volumetric IMRT techniques.

Cited by 7 publications

References 25 publications

Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

Axillary lymph node coverage with 3-dimensional tangential field irradiation and correlation with heart and lung dose

Quantifying the Mitigating Effects of Whole-Breast Radiotherapy and Systemic Treatments on Regional Recurrence Incidence Among Breast Cancer Patients

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