[an error occurred while processing this directive] | [an error occurred while processing this directive]
Radiation doses to axillary lymph nodes in patients with early breast cancer receiving field-in-field forward-planned intensity-modulated radiotherapy for whole breast irradiation after breast-conserving surgery
Zhu Chuanying*, Cai Gang, Hu Weigang, Yang Zhaozhi, Yu Xiaoli, Guo Xiaomao, Shao Zhimin, Jiang Guoliang, Chen Jiayi.
*Department of Radiation Oncology, Department of Breast Surgery, Cancer Hospital, Fudan University;Department of Oncology, Shanghai Medical College, Fudan University;Shanghai 200032, China
AbstractObjective To evaluate the radiation doses to the axillary lymph nodes in patients with early breast cancer receiving field-in-field forward-planned intensity-modulated radiotherapy (FIF-FP-IMRT) for whole breast irradiation after breast-conserving surgery, and to analyze the factors influencing the doses to the axillary lymph nodes. Methds Thirty-seven patients with breast cancer treated by breast-conserving surgery were evaluated. All patients received FIF-FP-IMRT for whole breast irradiation (not involving regional lymph nodes). Delineation of axillary levels I-III, interpectoral lymph nodes, and axillary vein was made on CT images, and a dosimetric analysis was made using 3D treatment planning software. Theinfluential factors for the dose distribution in axillary lymph nodes were analyzed by paired t-test. ResultsThe mean percent volumes receiving at least 95% of the prescribed dose (50 Gy/25 fractions for whole breast PTV)(V95) for axillary levels I, II, and III and interpectoral lymph nodes were 34.7%, 6.1%, 0.4%, and 39.6%, respectively, and the mean doses to axillary levels I, II, III and interpectoral lymph nodes were 30.8 Gy, 15.7 Gy, 5.0 Gy, and 28.8 Gy, respectively. The mean V95 values for the lymph node areas below and above the axillary vein were 45.6% and 0.7%, respectively, and the mean doses were 38.2 Gy and 6.7 Gy, respectively. The distance between the upper border of the radiation field and the humeral head was the only significant factor influencing the mean dose to the lymph node area below the axillary vein (P=0.037). Conclusions In FIF-FP-IMRT for whole breast irradiation, the actual dose delivered to the axillary lymph nodes below the axillary vein cannot be neglected and should be taken into consideration when analyzing the local control of the axillary lymph nodes after breast-conserving surgery.
Zhu Chuanying,Cai Gang,Hu Weigang et al. Radiation doses to axillary lymph nodes in patients with early breast cancer receiving field-in-field forward-planned intensity-modulated radiotherapy for whole breast irradiation after breast-conserving surgery[J]. Chinese Journal of Radiation Oncology, 2014, 23(6): 500-504.
Zhu Chuanying,Cai Gang,Hu Weigang et al. Radiation doses to axillary lymph nodes in patients with early breast cancer receiving field-in-field forward-planned intensity-modulated radiotherapy for whole breast irradiation after breast-conserving surgery[J]. Chinese Journal of Radiation Oncology, 2014, 23(6): 500-504.
[1] Reznik J, Cicchetti MG, Degaspe B, et al. Analysis of axillary coverage during tangential radiation therapy to the breast[J]. Int J Radiat Oncol Biol Phys,2005,61:163-168. [2] Lee JW, Hong S, Choi KS, et al. Performance evaluation of field-in-field technique for tangential breast irradiation[J]. Jpn J Clin Oncol,2008,38:158-163. [3] Feuvret L, Noel G, Mazeron JJ, et al. Conformity index:a review[J]. Int J Radiat Oncol Biol Phys,2006,64:333-342. [4] Chavaudra J, Bridier A.Definition of volumes in external radiotherapy:ICRU reports 50 and 62[J]. Cancer Radiother,2001,5:472-478. [5] Schlembach PJ, Buchholz TA, Ross MI, et al. Relationship of sentinel and axillary level I-II lymph nodes to tangential fields used in breast irradiation[J]. Int J Radiat Oncol Biol Phys,2001,51:671-678. [6] Orr RK. The impact of prophylactic axillary node dissection on breast cancer survival—a Bayesian meta-analysis[J]. Ann Surg Oncol,1999,6:109-116. [7] Fisher B, Jeong JH, Anderson S, et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation[J]. N Engl J Med,2002,347:567-575. [8] Reed DR, Lindsley SK, Mann GN, et al. Axillary lymph node dose with tangential breast irradiation[J]. Int J Radiat Oncol Biol Phys,2005,61:358-364. [9] Takeda A, Shigematsu N, Kondo M, et al. The modified tangential irradiation technique for breast cancer:how to cover the entire axillary region[J]. Int J Radiat Oncol Biol Phys,2000,46:815-822. [10] Takeda A, Shigematsu N, Ikeda T, et al. Evaluation of novel modified tangential irradiation technique for breast cancer patients using dose-volume histograms[J]. Int J Radiat Oncol Biol Phys,2004,58:1280-1288. [11] 陈剑,马金利,张盛箭,等.局部晚期和复发性乳腺癌患者区域淋巴结转移分布特点及靶区勾画意义[J]. 中华放射肿瘤学杂志,2011,20:123-127.
2014, Vol. 23 
