Trends and controversies in multidisciplinary care of the patient with breast cancer

Dominici, Laura; Morrow, Monica; Mittendorf, Elizabeth A.; Bellon, Jennifer R.; King, Tari A.

doi:10.1067/j.cpsurg.2016.11.003

Cited by 7 publications

(6 citation statements)

References 211 publications

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“…The management of breast cancer has evolved, particularly with regard to reducing treatment-related side effects without compromising treatment outcomes [1]. On the surgical side, the sentinel lymph node biopsy (SLNB) replaced axillary lymph node dissection (ALND) in the small tumors and in the absence of clinical lymph node involvement.…”

Section: Introductionmentioning

confidence: 99%

The Impact of an Incidental Dose on Axillary Tumor Control and Toxicity in Localized Breast Cancer: A Retrospective Analysis

Schmitt

Chambrelant

Chheang³

et al. 2022

Cancers

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Purpose: The dosimetric analysis of the incidental axillary dose delivered to axillary lymph node levels I–III by different techniques of whole breast irradiation and the analysis of prognostic factors of axillary recurrence of breast cancer. Methods: We perform a retrospective analysis that includes 171 patients with localized breast carcinoma irradiated at Centre Paul Strauss. To be included in the study, patients had to have a histological confirmation of breast cancer diagnosis, surgical treatment without axillary lymph node dissection (ALND), whole breast irradiation without axillary irradiation by a specific field, and a treatment plan available. Results: Three patients had lymph node recurrence. There was no significant correlation between the maximal or mean dose delivered at the three axillary levels and the risk of axillary lymph node recurrence. There was no significant correlation between the irradiation technique and the risk of axillary lymph node recurrence. Two patients, both in the HT group, had lymphoedema. There was significantly more lymphoedema in the HT group than in the ST and IMRT groups (p < 0.048). The mean dose in level II was significantly higher in the group of patients with lymphoedema (3.45 Gy (1.08; 9.62) vs. 23.4 Gy (23.1; 23.6)) (p < 0.02). Conclusion: The irradiation technique has an influence on the incidental dose delivered to the axillary area, but has no influence on the risk of axillary recurrence. The risk of lymphoedema could be related to the use of HT and the mean dose delivered at level II.

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Section: Introductionmentioning

confidence: 99%

The Impact of an Incidental Dose on Axillary Tumor Control and Toxicity in Localized Breast Cancer: A Retrospective Analysis

Schmitt

Chambrelant

Chheang³

et al. 2022

Cancers

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“…Breast cancer treatment has gradually evolved to reduce side effects without compromising treatment outcomes (1,2). Treatment-related side effects negatively affect quality of life, delay treatment, and compromise results.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of incidental axillary irradiation between three‑dimensional conformal and volumetric modulated arc techniques for breast cancer

Kim

et al. 2020

mol clin onc

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Radiotherapy techniques for breast cancer have evolved with efforts to reduce treatment-related side effects. In the present study, we conducted dosimetric analysis of incidental axillary irradiation between volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3D-CRT). A total of 20 patients with early stage left breast cancer who underwent breast-conserving surgery followed by postoperative radiotherapy were analyzed. For VMAT plans, dose-volume constraints were not imposed on the axilla, as with 3D-CRT. We compared the dosimetric parameters of the planning target volumes, organs at risk and axillary level I-III of the two plans. VMAT showed better target coverage and a normal organ-sparing effect compared with 3D-CRT. The incidental axillary irradiation of VMAT was lower; the mean dose and the V40 Gy were significantly reduced at all axillary levels, with the exception of no difference in the maximum dose to axillary level I. In conclusion, VMAT decreased incidental axillary irradiation, even in the absence of a dose-volume constraint on the axilla, and can, therefore, decrease the risk of radiotherapy-related lymphedema. However, caution is also required because it is unclear whether this incidental axillary irradiation is beneficial for reducing recurrence on the axilla.

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“…Surgery always plays an important role in the treatment of breast cancer. No matter how the method changes or the extent of the breast cancer surgery, ALND remains the standard surgical treatment for node- lymph node status, which is important as a prognostic factor for breast cancer (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

The application of methylene blue coloration technique in axillary lymph node dissection of breast cancer

Zou¹,

Wang²,

Zhang³

et al. 2019

Transl Cancer Res TCR

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Background:To analyze the associated factors that affect the coloration of methylene blue (MB) in axillary lymph node dissection (ALND) of patients with breast cancer and to explore the tracer effect of MB in high axillary lymph node metastasis, to guide surgical treatment.Methods: We recruited 170 patients who underwent ALND, all of them were injected MB before operation. We analyzed the relationships between the clinical factors of age, body mass index (BMI), molecular typing, TNM staging, neoadjuvant chemotherapy, injection time and position and the MB coloration by univariate and multivariate analyses. A total of 84 cases were selected for observation of the application value of MB during intervention involving the lymph nodes upper axillary vein.Results: Of 170 cases, 138 cases (81.17%) were colored. Univariate analysis showed that significant differences were observed between differing BMI's (χ 2 =24.074, P<0.0001) and injection times (χ 2 =41.207, P<0.0001). Multivariate analysis showed that injection time (P=0.016) was the clinical factor associated with MB coloration. More than 60 minutes before surgery and MB injection, the possibility of methylene blue colored was 0.088 times higher than 10 minutes (P=0.010, 95% CI, 0.014, 0.554). MB was used to track the lymph node upper axillary vein with a sensitivity of 12.5%, a specificity of 100%, a false negative rate of 87.50%, and a false positive rate of 0; the kappa coefficient was 0.051 (χ 2 =0.679, P=0.404).Conclusions: Among the clinical factors, MB coloration was worse more than 60 minutes before ALND.Using the technology of MB color, lymph nodes can be clearly identified. It has great guiding value for the doctors who learn the operation initially. However, it is still prudent to use MB for high lymph node dissection.

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Trends and controversies in multidisciplinary care of the patient with breast cancer

Cited by 7 publications

References 211 publications

The Impact of an Incidental Dose on Axillary Tumor Control and Toxicity in Localized Breast Cancer: A Retrospective Analysis

The Impact of an Incidental Dose on Axillary Tumor Control and Toxicity in Localized Breast Cancer: A Retrospective Analysis

Dosimetric comparison of incidental axillary irradiation between three‑dimensional conformal and volumetric modulated arc techniques for breast cancer

The application of methylene blue coloration technique in axillary lymph node dissection of breast cancer

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