Radiation Pneumonitis in Association with Internal Mammary Node Irradiation in Breast Cancer Patients: An Ancillary Result from the KROG 08-06 Study

Choi, Ji Sun; Kim, Yong Bae; Shin, Kyung Hwan; Ahn, Sung‐Ju; Lee, Hyung Sik; Park, Won; Kim, Su Ssan; Kim, Jin Hee; Lee, Kyu Chan; Kim, Dong Won; Suh, Hyun Suk; Park, Kyung Ran; Shin, Hyun Soo; Suh, Chang Ok

doi:10.4048/jbc.2016.19.3.275

Cited by 25 publications

(26 citation statements)

References 25 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, the role of IMN irradiation in patients with positive axillary lymph nodes remains controversial. Choi et al 21 reported that SRP occurred in 6.5% of patients who underwent IMN irradiation and in 3.3% of patients without IMN irradiation ( p = 0.047) and considered that IMN irradiation resulted in increased radiation exposure to the lung and a higher risk of developing SRP. Therefore, it is important to carefully select patients for treatment with IMN irradiation and adopt more accurate radiotherapy technology in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

New Clinical Features and Dosimetric Predictor Identification for Symptomatic Radiation Pneumonitis after Tangential Irradiation in Breast Cancer Patients

Wen¹,

Tan²,

Lan³

et al. 2017

J. Cancer

View full text Add to dashboard Cite

Background: Tangential irradiation is the most popular postoperative radiotherapy technique for breast cancer. However, irradiation has been related to symptomatic radiation pneumonitis (SRP), which decreases the quality of life of patients. This study investigated the clinical features and dosimetric parameters related to SRP of the ipsilateral lung to identify risk factors for SRP in breast cancer patients after three-dimensional conformal radiation therapy (3D-CRT) with tangential fields.Material and Methods: A total of 515 breast cancer patients were evaluated and divided into two groups: the local-regional irradiation group (259 patients) and the simple local irradiation group (256 patients). Clinical symptoms were registered and patient data collected. The relationship between the incidence of SRP and dosimetric parameters for the ipsilateral lung was assessed within 6 months after 3D-CRT. Dosimetric parameters were compared using t tests. The dosimetric predictors for SRP were estimated using a logistic regression model and receiver operating characteristic curve analysis.Results: In total, 19 patients (3.7%) developed grade 2 SRP. In the local-regional irradiation group, the probability of SRP in the lung body was greater than that in the lung apex (3.9% vs. 1.5%). V20 and V30 were independent predictors for SRP in the local-regional irradiation group (odds ratio = 1.152 and 1.439, both p = 0.030), whereas only V20 was an independent predictor of SRP in the simple local irradiation group (odds ratio = 1.351, p = 0.001). With 39.8% as the optimal threshold for V20 and 25.7% for V30 for local-regional irradiation, SRP could be predicted with an accuracy of 80.3% and 79.9%, a sensitivity of 61.5% and 69.2%, and a specificity of 81.3% and 80.5%, respectively. With 20.2% as the optimal V20 threshold for simple local irradiation, SRP could be predicted with an accuracy of 88.7%, a sensitivity of 83.3% and a specificity of 89.6%.Conclusions: SRP has become a rare complication with mild symptoms and occurs mainly in the lung body. V20 and V30 may be useful dosimetric predictors to evaluate SRP risk of the ipsilateral lung in breast cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

New Clinical Features and Dosimetric Predictor Identification for Symptomatic Radiation Pneumonitis after Tangential Irradiation in Breast Cancer Patients

Wen¹,

Tan²,

Lan³

et al. 2017

J. Cancer

View full text Add to dashboard Cite

show abstract

“…However, changes to the guidelines did not eliminate the controversies regarding irradiation of the internal mammary lymphatic chain. The reason was probably that the recurrence rate was only 2% according to clinical reports [13], and the irradiation dose of cardiopulmonary was increased by irradiation of the internal mammary lymphatic chain [14,15]. In this study, we retrospectively examined data from 114 patients with local and/or regional lymph node recurrence without adjuvant radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis on metastatic rate of the internal mammary lymph node and its clinical significance in adjuvant radiotherapy of breast cancer patients

Zhang

Wang

et al. 2020

BMC Cancer

View full text Add to dashboard Cite

Background: There is a discrepancy about the metastatic rate of internal mammary lymph nodes (IMNs) between clinical and pathologic findings. We aimed to investigate the metastatic rate of IMNs and to provide recommendations on target volume delineation of IMNs for adjuvant radiotherapy in breast cancer patients. Methods: We retrospectively analyzed data from 114 breast cancer patients treated with surgery without adjuvant radiotherapy who developed local and/or regional lymph node recurrence/metastasis at our institute from January 2015 to January 2019. Patients with widely lung or pleural metastases were excluded. We first analyzed the recurrence rate with the chest wall, the metastatic rate of internal mammary/anterior mediastinal, ipsilateral axillary and supraclavicular lymph nodes, and then investigated the distribution of the IMNs. Results: Among the 114 included patients, the recurrence rate with the chest wall, metastatic rate of IMNs, IMNs/anterior mediastinal lymph nodes, ipsilateral axillary lymph nodes, and the ipsilateral supraclavicular lymph nodes was 43, 37.7, 59.6, 12.3, and 22.8%, respectively. The metastatic IMNs were mainly located from the first to the second intercostal space. However, metastatic lymph nodes could also be observed above the upper edge of the first rib. Conclusions: The metastatic rate is high in the IMNs and irradiation of the internal mammary lymphatic chain is required. It is suggested that the upper bound of the internal mammary lymphatic chain should be up to the subclavian vein with a 5-mm margin, thus connecting to the caudal border of supraclavicular clinical target volume in breast cancer patients at high risk of recurrence.

show abstract

“…Changes in the guidelines did not eliminate the controversies of irradiation of internal mammary lymphatic chain. The reason was probably that the recurrence rate was only 2% according to clinical reports [13], and the irradiation dose of cardiopulmonary was increased by irradiation of the internal mammary lymphatic chain [14,15]. We studied 114 patients of local and/or regional lymph node recurrence without adjuvant radiotherapy retrospectively.…”

Section: Discussionmentioning

confidence: 99%

The metastasis of the internal mammary lymph node-a neglected strategic high point of radiotherapy for breast cancer

Li¹,

Zhang²,

Wang³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background : To investigate the metastatic rate of internal mammary lymph nodes (IMNs) and to provide recommendations on target volume delineation of IMNs for adjuvant radiotherapy of breast cancer patients. Methods : We retrospectively analyzed 114 breast cancer patients treated only by surgery without adjuvant radiotherapy who developed local and/or regional lymph node recurrence/metastasis in our institute from January 2015 to January 2019, and patients with widely lung or pleural metastases were excluded. We first analyzed the recurrence rate of the chest wall, the metastatic rate of internal mammary/anterior mediastinal, ipsilateral axillary and supraclavicular lymph nodes, and then investigated distribution of the IMNs. Results : Among all of these 114 patients, the recurrence rate of chest wall, the metastatic rate of IMNs, the IMNs/anterior mediastinal lymph nodes, the ipsilateral axillary lymph nodes, and the ipsilateral supraclavicular lymph nodes were 43%, 37.7%, 59.6%, 12.3% and 22.8%, respectively. The metastatic IMNs were mainly located from the first to the second intercostal space. However, metastatic lymph nodes could also be observed above the upper edge of the first rib. Conclusions : The metastatic rate is high in the IMNs and irradiation of the internal mammary lymphatic chain is indispensable. It is suggested that the upper bound of the internal mammary lymphatic chain should be up to the subclavian vein with 5 mm margin, thus connecting to the caudal border of supraclavicular CTV(Clinical Target Volume)in breast cancer patients with high risk of recurrence.

show abstract

Radiation Pneumonitis in Association with Internal Mammary Node Irradiation in Breast Cancer Patients: An Ancillary Result from the KROG 08-06 Study

Cited by 25 publications

References 25 publications

New Clinical Features and Dosimetric Predictor Identification for Symptomatic Radiation Pneumonitis after Tangential Irradiation in Breast Cancer Patients

New Clinical Features and Dosimetric Predictor Identification for Symptomatic Radiation Pneumonitis after Tangential Irradiation in Breast Cancer Patients

A retrospective analysis on metastatic rate of the internal mammary lymph node and its clinical significance in adjuvant radiotherapy of breast cancer patients

The metastasis of the internal mammary lymph node-a neglected strategic high point of radiotherapy for breast cancer

Contact Info

Product

Resources

About