Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma.

Recht, Abram; Pierce, Susan M.; Abner, Anthony; Vicini, Frank A.; Osteen, Robert T.; Love, Susan M.; Silver, Barbara; Harris, Jay R.

doi:10.1200/jco.1991.9.6.988

Cited by 253 publications

(119 citation statements)

References 34 publications

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“…In SLND studies, including the current study, the axillary lymph node recurrence rate after SLND is comparable to or less than the axillary lymph node recurrence rate of 1-2.5% after ALND for early-stage breast carcinoma at a median interval of 2.6 years between axillary surgery and disease recurrence. [17][18][19][20] The prevalence of axillary metastases is highly variable in patients with clinically negative lymph nodes and can be predicted based on the primary tumor size, ranging from 12.3% for T1a tumors, 18.5% for T1b tumors, 30.4% for T1c tumors, 48% for T2 tumors to 77.3% for T3 tumors. 21 The risk of axillary lymph node recurrence also varies accordingly.…”

Section: Discussionmentioning

confidence: 99%

Axillary disease recurrence after sentinel lymph node dissection for breast carcinoma

Swenson

Mahipal

Nissen

et al. 2005

Cancer

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BACKGROUNDSurgical recommendation for early‐stage breast carcinoma includes removal of the primary breast tumor and evaluation of the axillary lymph nodes on the ipsilateral side. Sentinel lymph node dissection (SLND) is increasingly being used to evaluate axillary lymph nodes in clinically lymph node negative patients as an alternative to axillary lymph node dissection (ALND). Results from SLND are highly predictive of metastatic involvement in the axilla, and are associated with fewer side effects. However, the greatest concern with SLND alone is the potential for a higher rate of axillary lymph node recurrence. The purpose of the current study was to review data collected on 700 consecutive patients with early‐stage breast carcinoma who underwent SLND without concomitant ALND.METHODSA retrospective study was conducted using the oncology registry at Park Nicollet Health Services (Minneapolis, MN). Consecutive breast carcinoma cases with SLND only for axillary surgery, from January 28, 1999 to December 31, 2003, were included in the study. During this period, 700 patients with breast carcinoma were identified who had SLND alone. Fifty‐two patients were excluded from the analysis because they had ductal carcinoma in situ.RESULTSWith a median follow‐up of 33 months (range, 2‐73 mos), axillary lymph node recurrence occurred in 4 of 647 (0.62%) patients overall. In these 4 patients, the axillary lymph node recurrences were isolated to the axillary lymph nodes and amenable to surgery.CONCLUSIONSData from the current study showed that axillary lymph node recurrence after SLND occurred very infrequently in early‐stage breast carcinoma, and these results were comparable to other studies. Cancer 2005. © 2005 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Axillary disease recurrence after sentinel lymph node dissection for breast carcinoma

Swenson

Mahipal

Nissen

et al. 2005

Cancer

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“…A further study in 234 patients (median follow-up 42 months) did not find an increased rate of axillary recurrence in patients with negative SLN or SLN micrometastases [93] . As the axillary recurrence rate should not exceed that seen after conventional axillary clearance surgery (1.0%-2.3%), the figures quoted above compare very favourably [94][95][96] .…”

Section: False Negative Ratementioning

confidence: 87%

What the clinician wants to know: radiation oncology perspective

Leer

2005

Cancer Imaging

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The delineation of the target volume, i.e. the volume which should be irradiated with a therapeutic dose of irradiation, is of utmost importance in radiotherapy. Modern imaging techniques cannot be missed in this process. Diagnosticians and radiation oncologists therefore should understand each other's needs and potential. Keywords: Radiotherapy; treatment planning; target volumes; biological target volume. Staging for radiotherapyRadiotherapy like surgery is a treatment for locoregional tumour growth. So, imaging modalities are extremely important for staging. Computerized tomography (CT), ultrasonography and magnetic resonance imaging (MRI) are used in the work-up of many tumours, e.g. in cervical cancer and head and neck tumours to detect lymph nodes, in rectal cancer to judge whether a free margin can be obtained to make the patient a suitable candidate for short term irradiation followed by surgery. New imaging modalities are also being introduced for staging such as fluorodeoxy glucose positron emission tomography (FDG-PET) scanning in lung cancer and MR lymphography with nanoparticles in prostate cancer. Image guided radiotherapy volumesWhereas surgery is tumour eradication under direct vision, radiotherapy is tumour eradication under indirect vision. So, imaging is of extreme importance for radiotherapy planning. In radiation oncology the target volume is that part of the body where a therapeutic dose of irradiation should be applied. This target volume is subdivided into several subsets: the gross tumour target volume (GTV), the clinical target volume (CTV) and the planning target volume (PTV). The GTV and CTV have a biological background. The GTV is what you can see, measure or palpate. The CTV is the suspected microscopic extension of the disease, and as in surgery, radiation oncologists also take a margin around the visible tumour. The GTV can include regional lymph nodes when microscopic spread to lymph nodes is expected; and when they should be treated electively, one could consider this as a nodal CTV. The PTV is a geometric and not a biological concept. This volume by two margins takes into account organ movement (internal margin) and positioning in accuracies and inaccuracies of the irradiation delivering equipment (set-up margin). The PTV is created to ensure that the therapeutic dose is indeed delivered to the CTV.Although one could imagine that the delineation of the GTV is most simple, we have to realise that different imaging modalities 'see' tumours or organs differently, e.g. the size of the prostate is different on MRI than CT. What is the truth? Often radiation oncologists use both. Consequently image registration or image fusion has become of paramount importance. Like surgery, in radiotherapy we also do some harm to normal tissues. Healthy tissue is unavoidably irradiated. However, the radiation dose in these tissues should be kept below tolerance which means below the dose which creates clinically manifest severe damage. For this reason a fourth volume in the irradiated part ...

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“…35 It also has been noted that such fields increase the incidence of pneumonitis and brachial plexopathy. 36 Potential limitations in our study warrant explanation. Details regarding RT fields and position were not always available in the patients who were treated at outside institutions; therefore, we assumed that, unless otherwise specified, those patients received RT with standard supine tangents.…”

Section: (7)mentioning

confidence: 87%

Radiation field design and regional control in sentinel lymph node‐positive breast cancer patients with omission of axillary dissection

Setton

Cody

Tan

et al. 2011

Cancer

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BACKGROUND: Randomized data suggest that axillary clearance is not necessary in select, clinically lymph nodenegative women with positive sentinel lymph node (SLN) biopsies (SLNBs) who undergo breast-conserving surgery or receive whole-breast radiotherapy and systemic therapy. The additional value of axillary radiotherapy in these patients is unknown. METHODS: The authors identified 326 patients with positive SLNBs who underwent breast-conserving surgery without axillary lymph node dissection from 1997 to 2009. SLN tumor deposits measured 0.2 mm in 58% of patients, 0.3 to 2.0 mm in 35% of patients, and >2 mm in 7% Patients. Ninety-three percent of patients received adjuvant radiotherapy. Radiation fields were categorized as standard tangents, high tangents, comprehensive (tangents plus supraclavicular), or partial breast to reflect coverage of the axilla. Standard tangents included both prone and supine positions. Regional failure was defined as recurrence in the ipsilateral supraclavicular, axillary, or internal mammary lymph nodes. RESULTS: The median follow-up was 55 months (range, 1-158 months). The 4-year rates of regional control, local control, disease-free survival, and overall survival were 99%, 98%, 95%, and 91%, respectively. Three patients had regional recurrences. Two of those patients received adjuvant radiotherapy with standard supine tangents, and 1 patient did not receive radiotherapy. No regional recurrences occurred among 66 patients who received radiotherapy in the prone position. CONCLUSIONS: Regional control was high (99% at 4 years) in patients who had low-volume SLN disease who did not undergo axillary dissection, regardless of whether the axilla was irradiated. Whole-breast radiation alone, including in the prone position, is sufficient treatment after breast-conserving surgery for select patients with tumor-containing SLNs who omit axillary dissection.

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Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma.

Cited by 253 publications

References 34 publications

Axillary disease recurrence after sentinel lymph node dissection for breast carcinoma

Axillary disease recurrence after sentinel lymph node dissection for breast carcinoma

What the clinician wants to know: radiation oncology perspective

Radiation field design and regional control in sentinel lymph node‐positive breast cancer patients with omission of axillary dissection

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