Role of Internal Mammary Node Radiation as a Part of Modern Breast Cancer Radiation Therapy: A Systematic Review

Is internal mammary nodes irradiation as a part of breast cancer postoperative radiotherapy necessary?

“…In addition, with advances in technology and equipment, will IMNI bring new benefits to breast cancer patients? A recently published systematic review explored these questions (7). A total of four RCTs, four non-RCTs, seven retrospective studies, and 1 previously published meta-analysis were included in this systematic review.…”

“…A total of four RCTs, four non-RCTs, seven retrospective studies, and 1 previously published meta-analysis were included in this systematic review. According to the authors, in some old RCTs, the differences in prognosis could not be identified in patients who had received IMNI or not due to limitations in technology or equipment (compared with the modern equipment) (7,10,20). Some newer RCTs, in contrast, have suggested that loco-regional lymph nodes radiotherapy (including IMNI) could improve the prognosis of patients by lowing the recurrence rate and even increasing the OS (7,11,12).…”

“…According to the authors, in some old RCTs, the differences in prognosis could not be identified in patients who had received IMNI or not due to limitations in technology or equipment (compared with the modern equipment) (7,10,20). Some newer RCTs, in contrast, have suggested that loco-regional lymph nodes radiotherapy (including IMNI) could improve the prognosis of patients by lowing the recurrence rate and even increasing the OS (7,11,12). Some non-RCTs and retrospective studies from the real word also indicated that radiotherapy (including IMNI) improved the prognosis (17,21,22).…”

“…According to some recent studies, in the background of the wide use of modern radiotherapy technology and equipment, radiotherapy (including IMNI) increased the pulmonary complications; however, these adverse reactions were often mild. In addition, few data on cardiac toxicity have been available (7). The systematic review concluded that, based on the currently available evidences, the benefits and harms of postoperative radiotherapy should be balanced for each patient, and IMNI is recommended for high-risk patients whose tumor is located at the central/medial area or in patients with positive axillary lymph nodes.…”

“…For breast cancer patients who had undergone breast-conserving surgery or a part of patients received modified radical mastectomy, radiotherapy plays a key role in the multidisciplinary treatment (3)(4)(5). However, it remains a controversy whether it is necessary to carry out internal mammary nodes (IMN) irradiation (IMNI) (6,7). In patients with breast cancer, the drainage areas of the IMN and the axillary lymph nodes have been regarded as the first nodal stations for lymphatic node drainage; however, the treatment for IMN drainage area remains controversial.…”