Influence of internal mammary node irradiation on long-term outcome and contralateral breast cancer incidence in node-negative breast cancer patients

Courdi, A.; Chamorey, Emmanuel; Ferrero, Jean-­Marc; Hannoun‐Lévi, Jean‐Michel

doi:10.1016/j.radonc.2013.06.028

Cited by 36 publications

(22 citation statements)

References 33 publications

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“…However, IMN metastases are found in at least 10% of patients where the axillary lymph nodes are negative. Overall survival and cancer-specific survival were increased in a large cohort of node negative breast cancer patients [102] that received IMN irradiation. It was found that melanoma patients with non-SLN metastases were three times more likely to die compared with patients where the metastasis was limited to the SLN [103].…”

Section: Targeting Lymph Node Metastasesmentioning

confidence: 99%

The lymph node microenvironment and its role in the progression of metastatic cancer

Pereira

Jones

Jung

et al. 2015

Seminars in Cell & Developmental Biology

151

136

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Lymph nodes are initial sites for cancer metastasis in many solid tumors. However, their role in cancer progression is still not completely understood. Emerging evidence suggests that the lymph node microenvironment provides hospitable soil for the seeding and proliferation of cancer cells. Resident immune and stromal cells in the lymph node express and secrete molecules that may facilitate the survival of cancer cells in this organ. More comprehensive studies are warranted to fully understand the importance of the lymph node in tumor progression. Here, we will review the current knowledge of the role of the lymph node microenvironment in metastatic progression.

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Section: Targeting Lymph Node Metastasesmentioning

confidence: 99%

The lymph node microenvironment and its role in the progression of metastatic cancer

Pereira

Jones

Jung

et al. 2015

Seminars in Cell & Developmental Biology

151

136

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“…With the wide availability of 3‐D planning, unifying target definition through contouring guidelines and quantification of dose to critical organs, safe targeting of the IMN while restricting RT dose to within the acceptable range can result in lowered toxicity . However, consensus on the benefit of IMN irradiation is lacking and the isolated LRR rates are low (≤1.5%) (Table ). Recently, Hennequin et al.…”

Section: Radiotherapy Technique Internal Mammary Nodal Irradiation mentioning

confidence: 99%

The Evolution of Regional Nodal Irradiation in Breast Cancer

Haffty

Mahmoud

2014

Breast J

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Breast cancer regional node management has witnessed many changes over the last decade. Advances in surgical techniques establishing sentinel lymph node biopsy as an alternative to axillary dissection, use of microarray technology for subtyping breast cancer to guide systemic therapy selection, and the expansion of the systemic therapy armamentarium including targeted agents have contributed to changing our strategy from one size fits all to a more tailored approach. There have also been recent landmark studies reported that significantly impact clinical practice in the regional nodal management of breast cancer. As the molecular era of personalized medicine is approaching, we hereby revisit the rational, benefit, and controversies of regional nodal irradiation in the light of the most recent publications.

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“…This can reduce increased rates of contralateral BC occurrence detected after IMLN irradiation in another French study. 7 Moreover, it can be proposed that irradiation of INLN in remaining 25.3% patients with scintigraphic signs of lymph flow from primary tumour to IMLN can significantly (13%) improve 10 year overall survival rates.…”

Section: Resultsmentioning

confidence: 99%

“…Later study by Postma et al 12 Localization of primary tumour significantly correlated with probability of lymph flow to IMLN. In order to calculate the probability of lymph flow from primary lesions, localized [3][4][5][6][7][8] As in descriptions of some studies we did not find figures that characterized patient distribution according to localization of primary lesion in the breast, we used average rate extracted from two large population based trials. 8,14 In accordance with these studies, we assumed that, on average, 32% of women with BC had internal/central and remaining 68% -external localization of primary tumour.…”

Section: Methodsmentioning

confidence: 99%

“…Obtained results indicated that in these patients with BC irradiation of IMLN can substantially (1-3%) reduce frequency of local and distant recurrences with borderline improvement in 5-10 year disease-free survival. [3][4][5][6][7][8] Small but reproducible improvement in overall survival that was mentioned in most studies pointed out that in some patients with BC irradiation of IMLN can evidently improve treatment efficacy. At the same time, it is clear that routinely used clinical factors (tumour localization, regional lymph node status) are not very powerful in discriminating those women who would benefit from IMLN irradiation and those who would not.…”

Section: Introductionmentioning

confidence: 98%

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Why do we need irradiation of internal mammary lymph nodes in patients with breast cancer: Analysis of lymph flow and radiotherapy studies

Nikolaevich

Vasilevich

2017

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tAim: Using clinical data and results of lymphoscintigraphy to calculate probability of internal mammary lymph node (IMLN) invasion by breast cancer (BC). To evaluate clinical value of lymphoscintigraphy as the guide for irradiation of IMLN.Methods: Using the data of eight published studies that analyzed lymph flow from primary BC (4541pts) after intra-peri-tumoral injection of nanosized 99mTc-colloids we determined probability of lymph-flow from internal-central and external BC to IMLN. In 7 studies (4359pts) axillary staging was accompanied by IMLN biopsy (911pts) that helped us to estimate probability of IMLN metastatic invasion in relation to the status of axillary LN. Finally, we estimated probability of IMLN invasion by BC in five randomized and observation studies that analyzed effect of IMLN irradiation on overall survival (OS). We calculated possible gain in survival if they would be treated according to lymph-flow guided radiotherapy to IMLN.Results: Lymph-flow from internal/central BC to IMLN was mentioned in 35% from external lesions -in 16% cases. In women with negative axillary LN metastases in IMLN were revealed in 7.8%pts, in the case of positive axillary nodes average risk of IMLN invasion increased to 38.1%. Calculated probability of IMLN metastatic invasion in pts included in evaluated trials did not exceed 10%. If lymphoscintigraphy would drive decision about irradiation of IMLN than 72-78% of pts included in these studies would escape radiotherapy to IMLN. In the remaining 21-28%pts with lymph-flow to IMLN their irradiation probably would increase gain in OS from 1.0-3.3% to 4.3-16.8%. Conclusion:Lymphoscintigraphy can be used to optimize the strategy of IMLN irradiation.

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Influence of internal mammary node irradiation on long-term outcome and contralateral breast cancer incidence in node-negative breast cancer patients

Cited by 36 publications

References 33 publications

The lymph node microenvironment and its role in the progression of metastatic cancer

The lymph node microenvironment and its role in the progression of metastatic cancer

The Evolution of Regional Nodal Irradiation in Breast Cancer

Why do we need irradiation of internal mammary lymph nodes in patients with breast cancer: Analysis of lymph flow and radiotherapy studies

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