Incidental axillary dose delivery to axillary lymph node levels I–III by different techniques of whole-breast irradiation: a systematic literature review

Schmitt, Martin; Pin, Y.; Pflumio, Carole; Mathelin, Carole; Pivot, Xavier; Noël, Georges

doi:10.1007/s00066-021-01808-y

Cited by 10 publications

(12 citation statements)

References 52 publications

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“…In the current study, we showed that the delivered dose to axillary levels I, II, and III varied significantly according to patient BMI and irradiation techniques. The values are consistent with several other previously published studies [15,16,20]. HT fields deliver a significantly higher mean dose at levels I, II, and III than the ST fields and IMRT.…”

Section: Discussionsupporting

confidence: 92%

“…In the case of whole breast or parietal irradiation, several studies have shown that a nonzero and heterogeneous dose, depending on the technique, was delivered unintentionally to the axillary area [15,16]. A study showed a trend between the irradiation technique and the risk of axillary recurrence (Schmitt et al, "A retrospective analysis of survival and prognostic factor of axillary recurrence of breast cancer", preprint) [17].…”

Section: Introductionmentioning

confidence: 99%

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The Impact of an Incidental Dose on Axillary Tumor Control and Toxicity in Localized Breast Cancer: A Retrospective Analysis

Schmitt

Chambrelant

Chheang³

et al. 2022

Cancers

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Purpose: The dosimetric analysis of the incidental axillary dose delivered to axillary lymph node levels I–III by different techniques of whole breast irradiation and the analysis of prognostic factors of axillary recurrence of breast cancer. Methods: We perform a retrospective analysis that includes 171 patients with localized breast carcinoma irradiated at Centre Paul Strauss. To be included in the study, patients had to have a histological confirmation of breast cancer diagnosis, surgical treatment without axillary lymph node dissection (ALND), whole breast irradiation without axillary irradiation by a specific field, and a treatment plan available. Results: Three patients had lymph node recurrence. There was no significant correlation between the maximal or mean dose delivered at the three axillary levels and the risk of axillary lymph node recurrence. There was no significant correlation between the irradiation technique and the risk of axillary lymph node recurrence. Two patients, both in the HT group, had lymphoedema. There was significantly more lymphoedema in the HT group than in the ST and IMRT groups (p < 0.048). The mean dose in level II was significantly higher in the group of patients with lymphoedema (3.45 Gy (1.08; 9.62) vs. 23.4 Gy (23.1; 23.6)) (p < 0.02). Conclusion: The irradiation technique has an influence on the incidental dose delivered to the axillary area, but has no influence on the risk of axillary recurrence. The risk of lymphoedema could be related to the use of HT and the mean dose delivered at level II.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The Impact of an Incidental Dose on Axillary Tumor Control and Toxicity in Localized Breast Cancer: A Retrospective Analysis

Schmitt

Chambrelant

Chheang³

et al. 2022

Cancers

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“…Furthermore, we found a lower risk of lymphedema in patients treated with IMRT. As regional nodal irradiation was not permitted and most patients received sentinel lymph node biopsy for axillary staging, this difference may be explained by differences in the incidental exposure to the axilla [ 30 , 31 ]. Our findings related to the choice of radiotherapy technique should be regarded as hypothesis-generating and need to be analyzed in future studies.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionation with simultaneous integrated boost after breast-conserving surgery: Long term results of two phase-II trials

Pfaffendorf¹,

Vonthein²,

Krockenberger-Ziegler³

et al. 2022

The Breast

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“…A recent systematic review identified 13 retrospective studies with a total of 475 patients which analyzed dosimetric parameters of axillary lymph node levels for patients planned for adjuvant whole breast radiotherapy [ 22 ]. There was considerable variation in axillary doses depending on the use of high tangents and radiation technique.…”

Section: Discussionmentioning

confidence: 99%

“…There was considerable variation in axillary doses depending on the use of high tangents and radiation technique. For patients treated with standard tangential 3DRT, median dose in axillary levels I-III ranged from 22 to 43.5 Gy, 3 to 35.6 Gy, and 1 to 20.5 Gy, respectively [ 22 ]. In addition to these retrospective studies, Hildebrandt et al recently published prospective data from the quality assurance program of the INSEMA-trial [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Incidental irradiation of the regional lymph nodes during deep inspiration breath-hold radiation therapy in left-sided breast cancer patients: a dosimetric analysis

et al. 2022

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Background Radiotherapy using the deep inspiration breath-hold (DIBH) technique compared with free breathing (FB) can achieve substantial reduction of heart and lung doses in left-sided breast cancer cases. The anatomical organ movement in deep inspiration also cause unintended exposure of locoregional lymph nodes to the irradiation field. Methods From 2017–2020, 148 patients with left-sided breast cancer underwent breast conserving surgery (BCS) or mastectomy (ME) with axillary lymph node staging, followed by adjuvant irradiation in DIBH technique. Neoadjuvant or adjuvant systemic therapy was administered depending on hormone receptor and HER2-status. CT scans in FB and DIBH position with individual coaching and determination of the breathing amplitude during the radiation planning CT were performed for all patients. Intrafractional 3D position monitoring of the patient surface in deep inspiration and gating was performed using Sentinel and Catalyst HD 3D surface scanning systems (C-RAD, Catalyst, C-RAD AB, Uppsala, Sweden). Three-dimensional treatment planning was performed using standard tangential treatment portals (6 or 18 MV). The delineation of ipsilateral locoregional lymph nodes was done on the FB and the DIBH CT-scan according to the RTOG recommendations. Results The mean doses (Dmean) in axillary lymph node (AL) level I, II and III in DIBH were 32.28 Gy (range 2.87–51.7), 20.1 Gy (range 0.44–53.84) and 3.84 Gy (range 0.25–39.23) vs. 34.93 Gy (range 10.52–50.40), 16.40 Gy (range 0.38–52.40) and 3.06 Gy (range 0.21–40.48) in FB (p < 0.0001). Accordingly, in DIBH the Dmean for AL level I were reduced by 7.59%, whereas for AL level II and III increased by 22.56% and 25.49%, respectively. The Dmean for the supraclavicular lymph nodes (SC) in DIBH was 0.82 Gy (range 0.23–4.11), as compared to 0.84 Gy (range 0.22–10.80) with FB (p = 0.002). This results in a mean dose reduction of 2.38% in DIBH. The Dmean for internal mammary lymph nodes (IM) was 12.77 Gy (range 1.45–39.09) in DIBH vs. 11.17 Gy (range 1.34–44.24) in FB (p = 0.005). This yields a mean dose increase of 14.32% in DIBH. Conclusions The DIBH technique may result in changes in the incidental dose exposure of regional lymph node areas.

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Incidental axillary dose delivery to axillary lymph node levels I–III by different techniques of whole-breast irradiation: a systematic literature review

Cited by 10 publications

References 52 publications

The Impact of an Incidental Dose on Axillary Tumor Control and Toxicity in Localized Breast Cancer: A Retrospective Analysis

The Impact of an Incidental Dose on Axillary Tumor Control and Toxicity in Localized Breast Cancer: A Retrospective Analysis

Hypofractionation with simultaneous integrated boost after breast-conserving surgery: Long term results of two phase-II trials

Incidental irradiation of the regional lymph nodes during deep inspiration breath-hold radiation therapy in left-sided breast cancer patients: a dosimetric analysis

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