Different radiation techniques to deliver therapeutic dose to the axilla in patients with sentinel lymph node-positive breast cancer: Doses, techniques challenges and clinical considerations

Impact of inter-observer variability on first axillary level dosimetry in breast cancer radiotherapy: An AIRO multi-institutional study

“…Conversely, for the infra-supraclavicular field (L2-L4), the L1-V90% was about 39.4% and Dmean was about 35 Gy, which was similar to the Dmean values of 36.8-38.6 Gy found in the present study for P1 and P2. The Dmean of 44.9 Gy for P3, with the arm set up at 90°, was comparable to the Dmean observed using high TFs in the study by Wang et al 10 In both cases, a larger proportion of L1 remained included in the breast/chest wall target volume when the upper border of the relative RT fields drew near the humeral head. In another comparative study, 9 the authors found that the amount of incidental dose depends on the TFs’ height and the body shape (lower values for small breast and slender patient).…”

“…17 Therefore, it might be expected that the unintentional dose to L1 is higher than that reported from the TFs of breast/chest wall RT with implications on both local control and arm toxicity. 17-19 In a simulation of the axillary dose distribution according to different treatment plans, the authors 10 found that the V90% and the Dmean delivered to L1 with the high TFs were as high as those delivered in the AMAROS study, which specifically targeted L1, with V90% being 79.5% and Dmean ⩾45 Gy. Conversely, for the infra-supraclavicular field (L2-L4), the L1-V90% was about 39.4% and Dmean was about 35 Gy, which was similar to the Dmean values of 36.8-38.6 Gy found in the present study for P1 and P2.…”

“…In literature there is paucity of data reporting the contribution of the third field to the incidental dose to the lower axilla in the locoregional RT. 9,10,16 The third field typically includes L3 and L4, while L2, as a whole or in its half medial part, is left to the ROs’ discretion, according to the national or institutional guidelines. 12 In the current study, the whole L2 was considered part of the nodal CTV, as required by the SENOMAC trial protocol.…”

“…Although the quantification of incidental dose to the axilla is hindered by the paucity of RT technical parameters for dosimetric correlations, it has been investigated in small, dedicated reports or in studies reproducing the condition of treatment of the landmark BC trials. [5][6][7][8][9][10] The SENOMAC trial, which has recently closed the accrual, challenged the need to irradiate L1 for slight sentinel node involvement and recommended limiting the regional RT field to L2, L3 and L4, regardless of the arm of randomisation. 11 In the locoregional RT, L1 is expected to receive a certain amount of the dose from the contribution of the breast/chest wall and the infra/supraclavicular fields, especially when this latter includes the whole or part of the second axillary level (L2).…”

Can Tumor-Infiltrating Lymphocytes (TILs) Be a Predictive Factor for Lymph Nodes Status in Both Early Stage and Locally Advanced Breast Cancer?

“…In the last three decades, treatment of breast cancer (BC) has changed remarkably, from invasive surgical interventions to breast-conserving surgery and new complementary and targeted therapies [1,2]. Development of radiotherapy regimens and techniques determined a new attitude towards the axilla, both in early stage and locally advanced tumors [3,4,5,6].…”