Clinically Apparent Internal Mammary Nodal Metastasis in Patients With Advanced Breast Cancer: Incidence and Local Control

Zhang, Yu Jing; Oh, Julia; Whitman, Gary J.; Iyengar, Puneeth; Yu, Tse Kuan; Tereffe, Welela; Woodward, Wendy A.; Perkins, George H.; Buchholz, Thomas A.; Strom, Eric A.

doi:10.1016/j.ijrobp.2009.06.081

Cited by 55 publications

(60 citation statements)

References 26 publications

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“…One of the most important strategies for the treatment of breast cancer is to control lymph node metastasis [31]. The regional lymph node status is not only critical for clinical staging and adjuvant therapy selection, but it is also the most significant independent factor for breast cancer prognosis [32].…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of Internal Mammary Lymph Node Metastasis in Breast Cancer Patients

Gu²,

Tong

et al. 2013

Onkologie

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Background: Knowing the status of the internal mammary lymph (IML) nodes is important for accurate staging and appropriate selection of subsequent treatment in breast cancer. We conducted a meta-analysis to clarify the rate of IML node metastasis in breast cancer patients and discussed the importance of this finding. Methods: We retrieved articles from the literature that reported positive rates of IML node metastasis in breast cancer patients. The quality of the selected articles was assessed using the ‘Methodological Index for Non-Randomized Studies'. The heterogeneity was tested, and publication bias was assessed using a funnel plot. Finally, the positive rate of IML node metastasis in breast cancer patients was calculated using the random-effects model. Results: 15 articles met the inclusion criteria and a total of 4,248 patients were included in the analysis. Heterogeneity across the studies was statistically significant (p = 0.014); thus, the random-effects model was used and the calculated positive rate of IML node metastasis was 23% (95% confidence interval (CI), 0.21-0.25). Conclusions: Approximately 23% of the breast cancer patients had IML node metastases, for which the prognosis is generally poor. Accurate staging and integrated treatment are necessary to improve the survival of these patients.

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Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of Internal Mammary Lymph Node Metastasis in Breast Cancer Patients

Gu²,

Tong

et al. 2013

Onkologie

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“…Zhang et al 39 went a step further to determine if there were imaging techniques that could be used for detecting positive IMN in a high risk group of patients with clinical N2 and N3. These authors used ultrasound, computed tomography, positron emission tomography/CT, and/or magnetic resonance imaging to identify 112/809 patients who presented with clinically positive internal mammary node disease (13.8%).…”

Section: Management Of Imn and Impact On Disease-free And Overall Patmentioning

confidence: 99%

Internal mammary node management in breast cancer. A review

Vrána¹,

Gatěk²,

Cwiertka³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Internal mammary nodes visualized during sentinel node biopsy for breast cancer, remain an unresolved management issue. Further, both internal mammary node (IMN) radiotherapy and biopsy have attendant risks and hence should be used with caution. The purpose of this review is to highlight the available data and evidence. Methods and Results. A PubMed database from 1960 to 2012 using key words: internal mammary nodes, breast cancer radiotherapy planning, adjuvant radiotherapy, sentinel node biopsy in breast cancer and selected publications on the significance of internal mammary nodes in breast cancer treatment, published data and approaches used. We found 14513 relevant papers and we selected 30 that clearly investigated the management of internal mammary nodes during sentinel node search. We focused on the incidence of IMN metastasis (6 papers), risk factors associated with IMN drainage (9 reports), management of IMN and the impact on disease free and overall patient survival (15 papers). Conclusions. The evidence for breast cancer axillary nodes management is good but the data for other draining nodes such as internal mammary nodes are far less conclusive and further research is needed.

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“…Although local eradication may be expected with combined chemotherapy and EBRT to breast cancer-IML-NM, some are refractory [2] . Dose escalation may be effective for overcoming radioresistance, but is generally associated with an increased likelihood of normal tissue complications [3] .…”

Section: Rationale Of the Present Techniquementioning

confidence: 99%

“…Although the incidence is rare in early stage [1] , IMLNM was found in 13.8% of patients with clinical N2 or N3 locally advanced disease [2] , of which 27.9% were refractory to chemotherapy and 11% were refractory to both chemo-and radiotherapy of 50 Gy to 72 Gy. Dose escalation is a key to overcome radioresistance.…”

Section: Introductionmentioning

confidence: 99%

Novel eradicative high-dose rate brachytherapy for internal mammary lymph node metastasis from breast cancer

Kishi

Tanino²,

Sonomura³

et al. 2012

WJR

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AIM:To develop a method of delivering an eradicative high radiotherapeutic dose safely preserving the surrounding skin in the treatment of internal mammary lymph node metastasis (IMLNM) of breast cancer. METHODS:We report a 38-year-old female patient with a solo IMLNM showing no response to 60 Gy in 2.5 Gy fractions of external beam radiotherapy. To eradicate this tumor, a boost brachytherapy plan was created after percutaneous insertion of an applicator needle into the IMLNM lesion avoiding the pleura and vessels under ultrasound monitoring. According to the dose distribution, the required thickness of a spacer between the skin and the tumor was determined, and hyaluronic gel was injected up to this thickness under ultrasound monitoring. We evaluated skin doses, target doses and clinical outcome. RESULTS:All procedures were performed easily. Sixteen Gy (34.7 Gy equivalent in 2 Gy fractions calculated by the linear quadratic model at α/β = 10: EQ�2, α/β = 10, cumulative total was 101.9 Gy EQ�10) to 100% of the target volume was irradiated with cumulative maximum skin dose of 70 Gy EQ�2, α/β = 3 which was 98.7 Gy EQ�2, α/β = 3 without spacer. No procedure related-or late complications and no local recurrence at the treated site were observed for three years until expiration. CONCLUSION:We consider that this procedure will provide an eradicative high-dose irradiation to IMLNM of breast cancer, preserving skin from overdose complications.

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Clinically Apparent Internal Mammary Nodal Metastasis in Patients With Advanced Breast Cancer: Incidence and Local Control

Cited by 55 publications

References 26 publications

A Meta-Analysis of Internal Mammary Lymph Node Metastasis in Breast Cancer Patients

A Meta-Analysis of Internal Mammary Lymph Node Metastasis in Breast Cancer Patients

Internal mammary node management in breast cancer. A review

Novel eradicative high-dose rate brachytherapy for internal mammary lymph node metastasis from breast cancer

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