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Comparison of two treatment strategies for irradiation of regional lymph nodes in patients with breast cancer: Lymph flow guided portals versus standard radiation fields - PubMed

  • ️Wed Jan 01 2014

Comparison of two treatment strategies for irradiation of regional lymph nodes in patients with breast cancer: Lymph flow guided portals versus standard radiation fields

Sergey Nikolaevich Novikov et al. Rep Pract Oncol Radiother. 2014.

Abstract

Aim and background: Radiotherapy being an essential part of breast cancer treatment, we evaluate various radiotherapy strategies in patients with breast cancer.

Materials and methods: Lymph node (LN) scintigraphy was performed in 172 primary patients with BC. LN visualization started 30-360 min after intratumoral injection of 75-150 MBq of 99mTc-nanocolloids. Our standard recommendation for postoperative radiotherapy in patients with LN invasion by BC were as follows: for patients with external localization of tumour - breast + axillary (Ax) + sub-supraclavicular (SSCL) regions; with internal localization - all above + internal mammary nodes (IM). Proposed strategy of lymph flow guided radiotherapy is based on the assumption that only regions that contain 'hot' LNs must be included in a treatment volume.

Results: Among 110 patients with external localization of BC, Ax LNs were visualized in all cases and in 62 patients it was the only region with 'hot' LN. Twenty-three patients (20.9%) had drainage to Ax + SSCL, 12 (10.9%) - Ax + IM, 13 (11.8%) - Ax + SSCL + IM regions. After the visualization of lymph flow patterns, standard treatment volume was changed in 87/110 cases (79.1%): in 56.4%, reduced, in 22.7%, enlarged or changed. In 62 patients with tumours in internal quadrants, we revealed the following patterns of lymph-flow: only to the Ax region in 23 (37.1%); Ax + IM, 13 (21%); Ax + SSCL, 15 (24.2%); Ax + IM + ISSCL, 11 (17.7%) cases. After lymph-flow visualization, the standard irradiation volume was reduced in 53/62 (85.5%) cases.

Conclusion: Visualization of an individual lymph flow pattern from BC can be used for the optimization of standard fields used for irradiation of regional LNs.

Keywords: Breast cancer; Radiotherapy; Sentinel lymph-nodes.

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References

    1. Poortmans P. Evidence based radiation oncology: breast cancer. Radiother Oncol. 2007;84:84–101. - PubMed
    1. Early Breast Cancer Trialists’ Collaborative Group Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014 - PMC - PubMed
    1. Courdi A., Chamorey E., Ferrero J.-M., Hannoun-Levi J.-M. Influence of internal mammary node irradiation on long-term outcome and contralateral breast cancer incidence in node-negative breast cancer patients. Radiother Oncol. 2013;108:259–263. - PubMed
    1. Poortmans P., Struikmans H., Collette S. Lymph node RT improves survival in breast cancer: 10 years results of the EORTC ROG and BCG phase III trial 22922/10925. Radiother Oncol. 2014;111(Suppl. 1) 217 [OC-0523]
    1. Recht A., Pierce S.M., Abner A. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1991;9:988–996. - PubMed

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