Irradiation axillaire prophylactique « de diffusion » dans le cancer du sein — revue de la littérature

Does Breast Surgery Type Alter Incidental Axillary Irradiation? A Dosimetric Analysis of the “Sentinel Envahi et Randomisation du Curage” SERC Trial

“…In our sub-study, we report a better covera of the Berg level 1: 54.6% received at least 95% of the prescribed dose of radiotherapy the chest wall and regional lymph nodes after a mastectomy without reconstruction. report here the same range of the dose received by the Berg level 1 as published data af conservative surgery: from 22 to 43.5 Gy compared to 37.2 Gy in our sub-study [10].…”

“…The published data concerning this incidental axillary dose vary widely; Berg level 1 coverage is described as between 30 and 50% for 95% of the prescribed dose with standard tangential beams and between 1 and 39% with heterogeneous IMRT techniques. Some authors describe this coverage as inadequate [ 10 ]. However, axillary recurrence rates are thought to decrease after whole-breast radiotherapy under conservative treatment, which would explain the low rate of axillary recurrence in axillary lymph node dissection omission (ALND) trials [ 4 , 15 , 16 ].…”

“…Many studies have reported the AID after BCS, with highly variable data depending on the technique used [ 10 ]. The increasing use of the IMRT technique in breast cancer radiotherapy is a source of concern due to the risk of axillary underdosing.…”

“…Indeed, breast and chest-wall irradiation has long been based on standard tangential fields and 3D conformal radiotherapy (3D-CRT). In a systematic literature review on axilla incidental radiation dose in patients treated with BCS, Schmitt et al demonstrated that by using standard tangential fields and 3D conformal radiotherapy (3D-CRT), the average dose delivered to the axilla level I ranged between 20 and 43.5 Gy [ 10 ]. However, intensity-modulated radiotherapy (IMRT), delivering a more conformal dose distribution with a better coverage of target volumes, has been used in the treatment of breast cancer for 10 years, with the advantage of better sparing organs at risk [ 11 ].…”

“…Nevertheless, it increases low doses to healthy organs, with the risk of long-term side effects such as radiation-induced cancers. The total incidental axillary dose is technique-dependent and seems to decrease with IMRT, with considerable variability reported between authors, ranging from 14.5 to 42.6 Gy [ 10 ]. Some authors have reported a fixed-beam IMRT technique; others have reported a volumetric arc therapy (VMAT) technique, which consists of a rotational IMRT with the use of treatment arcs.…”