Incidental radiation to axilla in early breast cancer treated with intensity modulated tangents and comparison with conventional and 3D conformal tangents

Kataria, Tejinder; Bisht, Shyam Singh; Gupta, Deepak; Goyal, Shikha; Jassal, Kannan; Agarwal, Abhishek; Sharma, Kuldeep; Pareek, Puneet; Kumar, Vijay; Jain, Siddharth; Tayal, Manoj; Karthikeyan, N

doi:10.1016/j.breast.2013.07.054

Cited by 25 publications

(25 citation statements)

References 22 publications

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“…23 A meta-analysis by van Wely et al 24 showed that external-beam radiotherapy to the breast was associated with a lower axillary recurrence rate compared to that in patients who did not receive it as part of initial therapy. Although it may not be considered therapeutic, 25 the dose delivered to the region in which the SLNs are normally found could well influence the natural evolution of residual tumor cells. The presence of lymph node metastases does not necessarily imply a further clinically evident development of the disease.…”

Section: Discussionmentioning

confidence: 99%

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

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We performed a retrospective analysis of 1156 patients affected by early breast cancer in order to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. Background: The role of axillary surgery for early breast carcinoma treated with conservative surgery and radiotherapy is currently the subject of considerable investigation. Recent studies have supported the noninferiority of avoiding axillary surgery in terms of overall survival when sentinel lymph node biopsy (SLNB) presents 2 positive lymph nodes, thus sparing the patients from complications. There are some ongoing studies investigating the possibility of omitting SLNB. Axillary study seems to be sufficiently replaced by SLNB for staging the disease. Axillary surgery maintains a therapeutic role in the presence of > 2 metastatic lymph nodes at SLNB. Patients and Methods: We performed a retrospective analysis of 1156 patients with early breast cancer to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. Results: Of the 1156 cases, only 106 (9.2%) had > 2 axillary metastatic lymph nodes. More specifically, 38 (4.3%) of 884 T1 cases, and 6 (2.3%) of 257 of T1b cases had > 2 metastatic lymph nodes. Conclusion: The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. The ongoing studies on avoiding SLNB will likely prove the noninferiority of omitting biopsy because these studies are conducted in the whole population of early breast cancers. It is necessary to identify more accurately the subpopulation of patients who may benefit from axillary surgery.

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Section: Discussionmentioning

confidence: 99%

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

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“…It is possible that in some cases, incidental irradiation to axilla might have taken care of micrometastases as demonstrated by our group in an earlier publication. 21 Even when axilla was not a part of target volume, nearly 50% dose was delivered to the axilla in the IMRT plans, and may have been sufficient to address the microscopic disease in a small proportion of patients.…”

Section: Discussionmentioning

confidence: 99%

Modulated Radiotherapy for Breast Cancer: Locoregional Outcomes

Kataria

Goyal

Malik

et al. 2016

IJRRT

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“…So far, several studies have evaluated axillary dose levels using different techniques, and found dose distribution was directly influenced by the breast volume and shape (18)(19)(20)(21). Active breathing control (ABC) technique can reduce the IMN coverage in left-sided breast cancer patients planned for postmastectomy radiation therapy (PMRT) (22).…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing the Incidental Dose Distribution in Internal Mammary Nodes: A Comparative Study

Wang

Qiu

et al. 2020

Front. Oncol.

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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 (D T), ratio of D T to the thoracic anteroposterior diameter (D AP)(R T/AP), planning target volume of IMN (PTV IMN) included in PTV (IMNin) and the ratio of IMNin to PTV IMN (R IMNin) and PTV posterior border were the parameters affecting IIMNI dose. In multivariate analysis, body weight, R T/AP , and R IMNin 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 R IMNin .

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Incidental radiation to axilla in early breast cancer treated with intensity modulated tangents and comparison with conventional and 3D conformal tangents

Abstract: Axillary levels I and II (lower axilla) receive substantial amount of incidental radiation doses with all the three techniques; however, conformal techniques (IMRT, 3DCRT) deliver significantly lesser incidental radiation to lower axilla than ST technique.

Cited by 25 publications

References 22 publications

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Modulated Radiotherapy for Breast Cancer: Locoregional Outcomes

Factors Influencing the Incidental Dose Distribution in Internal Mammary Nodes: A Comparative Study

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