Dose coverage of axillary levels I-III and sentinel lymph node area by inverse-planned intensity-modulated radiotherapy for whole breast irradiation in patients with breast cancer after breast-conserving surgery
Zhang Li*, Wang Yujie, Yu Xiaoli, Chen Jiayi, Chen Lanfei, Wang Junqi, Liu Guangyu, Guo Xiaomao.
Department of Radiation Oncology, Fudan University Shanghai Cancer Center;Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Abstract：Objective To evaluate the dose coverage of axillary levels I-III and the sentinel lymph node (SLN) area by multi-field inverse-planned intensity-modulated radiotherapy (IMRT) for whole breast irradiation in patients with early breast cancer after breast-conserving surgery. Methds A retrospective analysis was performed on the clinical data of 40 patients with early breast cancer who underwent breast-conserving surgery and SLN biopsy in Fudan University Shanghai Cancer Center from 2008 to 2012. After surgery, inverse-planned IMRT for whole breast irradiation was performed at a dose of 50 Gy/25 fractions. The axillary levels I-III were delineated according to the RTOG criteria, and the SLN CTV was defined as 2 cm in diameter around the clip. Dose-volume parameters were used to calculate the dose distribution of these lymph node areas. Results The mean doses delivered to axillary levels I, II, and III were (33.0±7.5) Gy, (17.9±11.3) Gy, and (7.3±6.6) Gy, respectively. The percent volumes receiving at least 95% of the prescribed dose for axillary levels I, II, and III were (29.9±17.7)%, (9.0±14.5)%, and (0.1±0.3)%, respectively. All SLNs were located in axillary level I area;the mean dose received by the SLN area was (43.0±10.0) Gy, and 58%(19/33) of SLNs received a dose greater than 45 Gy. Conclusions The multi-field inverse-planned IMRT offers a limited dose coverage to axillary levels I-III in patients receiving inverse-planned IMRT for whole breast irradiation. For those patients with SLN micrometastases and without axillary lymph node dissection, we need to keep an eye on the dose coverage of the axillary area.
Zhang Li,Wang Yujie,Yu Xiaoli et al. Dose coverage of axillary levels I-III and sentinel lymph node area by inverse-planned intensity-modulated radiotherapy for whole breast irradiation in patients with breast cancer after breast-conserving surgery[J]. Chinese Journal of Radiation Oncology, 2014, 23(6): 468-471.
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