Elective Regional Nodal Irradiation in Patients With Early-Stage Breast Cancer

Xie, Liyi; Higginson, Daniel S.; Marks, Lawrence B.

doi:10.1016/j.semradonc.2010.08.006

Cited by 22 publications

(13 citation statements)

References 88 publications

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“…The risk of supraclavicular lymph node involvement is greater when 4 or more lymph nodes are positive for axillary dissection. In these cases, SCF radiotherapy is indicated because evidence exists that this method reduces the chance of nodal recurrence and progression to systemic disease and improves the effect on disease-free survival and OS rates [21]. SCF radiotherapy increased the rate of lymphedema by 1.87.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Arm Lymphedema in a Cohort of Breast Cancer Patients Followed up for 10 Years

et al. 2015

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Background: The etiology of lymphedema is multifactorial, and definition criteria of lymphedema, its limitation, and follow-up must be considered in studies related to risk factors. The aim of this study is to evaluate risk factors related to arm lymphedema in a cohort study with a long follow-up. Patients and Methods: The study was performed in 622 breast cancer patients. The main endpoint reported was the presence of clinical lymphedema reported in medical records. Univariate and multivariate regression analyses were performed to identify factors related to lymphedema. Results: 66.4% of the patients were submitted to mastectomy, 88.4% to level III axillary lymphadenectomy, 34.9% to radiotherapy in the supraclavicular fossa, and 4.3% to axillary radiotherapy. The mean follow-up was 96.7 months. 45 patients (7.2%) developed lymphedema, of which 82.2% had developed lymphedema at 60 months. Univariate regression analysis showed that supraclavicular radiotherapy, adjuvant/palliative chemotherapy, ≥ 15 lymph nodes dissected, and axillary surgery increase the lymphedema rate by 1.87, 2.28, 2.03, and 6.17, respectively. Adjusted multivariate regression analysis showed that the combination of axillary dissection and number of lymph nodes dissected was the main factor related to lymphedema (p = 0.017). Conclusion: In the pre-sentinel era, axillary dissection and the number of lymph nodes resected are related to 10-year lymphedema.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Arm Lymphedema in a Cohort of Breast Cancer Patients Followed up for 10 Years

et al. 2015

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“…IMNI has been shown to have a significant impact on locoregional control, breast cancer mortality, and OS (5-7), but controversies concerning IMNI still exist, mainly because of radiotherapy-induced longterm lung and heart toxicity (8,24,25). Though the incidental dose to the IMNs not achieve clinically significant therapeutic levels (26,27), recent studies have demonstrated that accepting adequate doses during incidental irradiation can result in a clinical benefit (6,10). By determining the variability in the IIMNI dose coverage with standard chest wall tangential fields (28,29).…”

Section: Discussionmentioning

confidence: 99%

“…For patients with breast cancer (stage I, II, or III), observed IMN recurrence rate was <1% after primary breast cancer treatment, even when the IMNs are not excised or irradiated (6,10). Patients most likely benefit from systemic therapies and incidental regional node irradiation (11,12).…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing the Incidental Dose Distribution in Internal Mammary Nodes: A Comparative Study

Wang

Qiu

et al. 2020

Front. Oncol.

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Objective: To investigate the effect of anatomic and technical parameters on the incidental internal mammary lymph node (IMN) irradiation (IIMNI) dose among postmastectomy patients. Methods: We retrospectively delineated the IMN on planning CT images from 138 patients who had undergone postmastectomy radiotherapy (PMRT). We analyzed the IIMNI dose coverage and its relationship with anatomic and technical parameters. Results: The IIMNI mean dose was 32.85 ± 9.49 Gy, and 10 of 138 patients (7.25%) treated with PMRT received ≥45 Gy. In univariate analysis, the body weight, body mass index, body surface area, thoracic transverse diameter (D T), ratio of D T to the thoracic anteroposterior diameter (D AP)(R T/AP), planning target volume of IMN (PTV IMN) included in PTV (IMNin) and the ratio of IMNin to PTV IMN (R IMNin) and PTV posterior border were the parameters affecting IIMNI dose. In multivariate analysis, body weight, R T/AP , and R IMNin were correlative factors that affected IIMNI dose. Conclusions: For patients who underwent PMRT without IMN irradiation (IMNI), there was a wide variety in IIMNI doses. A minority of patients had adequate IIMNI dose coverage, and the higher IIMNI doses were associated with the less body weights and more R IMNin .

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“…This difference between pathological nodal positivity and axillary nodal recurrence has been called the 'Recurrence Gap' by Liyi Xie [4]. The article goes on to hypothesize four reasons for this phenomenon -the effect of systemic therapy, incidental radiation of nodes, under reporting of nodal recurrence and competing risk of metastatic disease.…”

Section: Comparison Of Surgery Versus Observation In the Pre Sentinelmentioning

confidence: 99%

Management of Axilla in 2015 in Indian Scenario

Vijaykumar

Arunlal

2015

Indian J Surg Oncol

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Sentinel lymph node biopsy is now increasingly being considered the favored method to treat low volume axilla. Most often this is followed by adjuvant radiation directed at axilla. In India however, sentinel node itself is still not widely practiced. The radiotherapy facilities are also not uniform, with cobalt units still being used in many centers. The long-term complications related to radiation are not assessed well. In fact there are also questions whether the evidence from early screen detected cancers in western population can be blindly followed in our population with a possibly different tumor biology and presentation as locally advanced being the norm. However, it is possible that we will see lesser axillary surgery in the minimal axillary disease group, in the not so distant future. We will look at the emerging evidence with an open mind and try to look at how this is applicable to our scenario.

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Elective Regional Nodal Irradiation in Patients With Early-Stage Breast Cancer

Cited by 22 publications

References 88 publications

Risk Factors for Arm Lymphedema in a Cohort of Breast Cancer Patients Followed up for 10 Years

Risk Factors for Arm Lymphedema in a Cohort of Breast Cancer Patients Followed up for 10 Years

Factors Influencing the Incidental Dose Distribution in Internal Mammary Nodes: A Comparative Study

Management of Axilla in 2015 in Indian Scenario

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