A Paradigm Shift in Axillary Breast Cancer Treatment; From “Treat All-Except,” Toward “Treat None-Unless”

Hoven, Ingrid van den; Voogd, Adri C.; Roumen, R. M. H.

doi:10.1016/j.clbc.2015.07.002

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…Trial conducted by American College of Surgeons Oncology Group (Z0011) randomized patients treated with breast conservation surgery and positive sentinel node biopsy (SNB) to standard axillary dissection or no further surgery, followed by radiation to breast alone in both the arms. The study concluded that at a median follow-up time of 6.3 years, there were no statistically significant differences in local recurrence (P=0.11) or regional recurrence (P=0.45) between the 2 groups [12]. One possibility is that dose less that 95% of prescription dose is adequate to treat clinically negative axilla/microscopic disease.…”

Section: Discussionmentioning

confidence: 96%

“…Many studies have shown there will be better long term axillary control with breast irradiation and higher nodal recurrence when breast irradiation is skipped [11,12]. That can have direct correlation, with standard tangents, the axilla receives a significant incidental dose but still adequate for clinical control of disease is unknown [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…In a trial conducted by American College of Surgeons Oncology Group (Z0011), randomized patients of early breast cancer who underwent breast conservation surgery and had positive sentinel node biopsy (SNB) to standard axillary dissection or no further axillary surgery, followed by radiation to breast alone in both the arms. The study concluded that axillary failures were same in both the arms [12] raising the possibility that incidental dose of radiation to axilla when breast is being irradiated might contribute in eradicating microscopic disease in undissected axilla.…”

Section: Introductionmentioning

confidence: 98%

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Comparison of Incidental Radiation Dose to Axilla and Internal Mammary Nodal Area by Conventional, 3DCRT, and IMRT Technique in Carcinoma of Breast

Hb¹,

Thimmaiah²,

Ia³

et al. 2017

J Nucl Med Radiat Ther

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Purpose: To quantify the incidental radiation dose delivered to axilla and internal mammary nodal (IMN) area by Conventional Tangential Radiation Therapy (CRT), 3 Dimensional Conformal Radiation Therapy (3DCRT) and Intensity Modulated Radiation Therapy (IMRT). Methods and Materials:We prospectively evaluated incidental radiation to axilla in twenty cases of breast cancer treated with adjuvant radiation therapy. Three plans were generated for each case, comprising CRT, 3DCRT and IMRT tangents. Radiation doses to axillary levels I, II, III, and IMN areas were evaluated for mean dose, V95, V80 and V50. Comparisons were made using ANOVA. Results:The mean volume and range of the axillary level I, II, III, and IMN were 61.1 cc and 142-57 cc; 42.6 cc and 61-21cc; 19.5 cc and 34-15 cc; 13.2 cc and 21-9 cc respectively. The mean dose to axilla by 3 techniques (by IMRT, 3DCRT and CRT) to Level I, II, III, and IMN were 75%, 53%, 38%, and 61% vs. 81%, 64%, 44% and 77% vs. 92%, 86%, 53% and 92% respectively (p<0.05). The V95 values (volume receiving 95% of dose) for the three techniques were 43%, 39%, 17% and 49% by IMRT: 40%, 45%, 21% and 59% by 3DCRT; 72%, 61%, 24% and 65% by CRT (IMRT vs. 3DCRT for level II axilla, IMRT vs. CRT and 3DCRT vs. CRT-p<0.05) The V80 were 49%, 53%, 29%, and 57% by IMRT; 55%, 47%, 34% and 68% by 3DCRT; 85%, 77%, 44% and 69% by CT (IMRT vs. 3DCRT for level III axilla and IMN, IMRT vs. CRT and 3DCRT vs. CRT -p<0.05). The V50 values were 75%, 65%, 41% and 66% by IMRT; 82%, 53%, 57% and 84% by 3DCRT; 94%, 89%, 42% and 90% by CRT (IMRT vs. 3DCRT, IMRT vs. CRT, and 3DCRT vs. CRP-p<0.05). Conclusion:Axillary and internal mammary nodal areas receive substantial amount of incidental radiation doses with all the three techniques; however, conformal techniques (IMRT, 3DCRT) deliver significantly lesser incidental radiation to lower axilla than CRT technique.

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Section: Discussionmentioning

confidence: 96%