Mammary Node Chain Research Articles

Comparison of Static Fields IMRT and Helical IMRT for Accelerated Partial Breast Irradiation

Purpose/Objective(s): Bilateral cancer breast irradiation is a real challenge in the field of radiation therapy, especially in case of axillary nodes involvement. VMAT is an interesting technique to achieve suitable target volume coverage while sparing organs at risk (OAR) when compared to 3D-conformal radiation therapy. Here, we present results of treatment planning of 20 consecutive bilateral breast cancer patients treated in our institution. Materials/Methods: Twenty consecutive bilateral breast cancer patients were treated using VMAT technique from July 2011 to December 2013. Target volumes (CTV, GTV) were delineated according to RTOG guidelines. The prescribed doses were 63.2 Gy to PTVof boost (n Z 17), 52.2 Gy to PTVof whole breast (n Z 20) and of internal mammary chain (IMC) nodes (n Z 9) and 49.3 Gy to PTV of the supraclavicular (SC) nodes (n Z 9) in 29 fractions. The V95% for CTV breast should be larger or equal to 99% and V95% for all other CTVs larger or equal to95%. Values of PTV and OAR exposure were collected. Results: Main results are summarized in the following table.

Region of Treatment in Radiotherapy and Second Malignancies in Breast Cancer Patients

A cohort study was conducted based on clinical records for 5248 women treated for breast cancer in Florence (Italy), with continuous follow up from 1965 to 1994. The subjects were categorised into groups such as no radiation treatment; breast dose only; and radiation doses in one, two, three or four of the following fields: namely internal mammary chain, supraclavicular nodes, axillary lymph nodes and chest wall. The Cox proportional hazards model for ungrouped survival data was used to estimate the relative risk for second cancer after radiotherapy delivered to different regions. The relative risk for all second cancers combined was statistically significantly raised if the internal mammary chain and supraclavicular nodes were irradiated. However, we found that the relative risk of the second malignancies could be reduced if all the locoregional lymph nodes (the internal mammary chain, supraclacicular nodes, axillary nodes) and chest wall are irradiated at the same time. If this finding can be verified by other large cohort studies or randomized clinical trials, it may have implications in clinical practice when deciding upon the targeted areas for radiotherapy; partial radiation treatment of the locoregional lymph nodes could raise the risk of second malignancies and should ideally be avoided.

CT-Scan Based Localization of the Internal Mammary Chain and Supra Clavicular Nodes for Breast Cancer RadiationTherapy Planning

CT-Scan Based Localization of the Internal Mammary Chain and Supra Clavicular Nodes for Breast Cancer RadiationTherapy Planning

Concurrent administration of weekly trastuzumab and adjuvant breast radiotherapy increases skin, esophageal, and cardiac acute toxicities

630 Background: Trastuzumab (T) combined with chemotherapy (CT) has been recently shown to improve the outcome in patients with HER2-positive breast cancer. Its administration either weekly or every 3 weeks for one year is recommended as adjuvant therapy. Nevertheless, little is known about the toxicity of radiotherapy (RT) and T administered concurrently. Methods: Since June 2005, 95 patients (pts) with stage II-III HER2-positive breast cancer were treated concurrently with adjuvant T and RT. At this time, 53 have completed their combined therapy. Median age was 48y and 22 pts were menopausal. Twelve and 41 pts received T weekly or every 3 weeks, respectively. Neoadjuvant CT using anthracyclin/taxane regimen was administered in 27 pts. T was initiated after the last cycle of anthracyclin. Hormonal treatment was given to 17 hormone-receptor positive pts. RT was delivered to the whole breast (45–50 Gy ± a 10 to 16 Gy-boost, n=24) or to the chest wall (50 Gy, n=29). Internal mammary chain (IMC) and supraclavicular nodes were irradiated in 41 pts. Toxicity assessment (dermatitis, esophagitis and left ventricular dysfunction) was implemented according to the CTC v3.0 criteria. Results: Grade (G) 2 or more skin and esophageal toxicities were observed in 27/53 (51%) and 7/53 (13%) pts, respectively. Post-RT left ventricular dysfunction was observed in 22 pts (G1 in 14, G2 in 6, and G3 in 2). In univariate analyses, unfavorable factors influencing G2 or more cardiac toxicity were postmenopausal status (p=0.03), IMC irradiation (p=0.005) and weekly T administration (p=0.0001). Multivariate analysis revealed the concurrent administration of weekly T and RT (WTRT) as an unfavorable independent prognostic factor for cardiac toxicity (p=0.0001) and for G2 or more dermatitis (p=0.05). The two unfavorable prognostic factors for esophagitis (G2 or more) were concurrent administration of WTRT (p=0.008) and total mastectomy (p=0.004). Conclusion: Our preliminary results show that in addition to increased skin and esophageal acute toxicities, concurrent administration of weekly T and RT significantly decreases the left ventricular ejection fraction compared to the 3-week schedule. Results for the whole cohort will be presented at the meeting. No significant financial relationships to disclose.

The importance of patient's position in CT-scan based localization of the Internal Mammary Chain (IMC) and Supra Clavicular Nodes (SCN) for breast cancer (BC) radiation therapy planning

The importance of patient's position in CT-scan based localization of the Internal Mammary Chain (IMC) and Supra Clavicular Nodes (SCN) for breast cancer (BC) radiation therapy planning

CT-scan Based Localization of the Internal Mammary Chain (IMC) and Supra Clavicular Nodes (SCN) for Breast Cancer (BC) Radiation Therapy Planning

CT-scan Based Localization of the Internal Mammary Chain (IMC) and Supra Clavicular Nodes (SCN) for Breast Cancer (BC) Radiation Therapy Planning

Sentinel nodes scintigraphy of the internal mammary chain in breast cancer

Abstract Internal mammary chain lymphnodes (IMNs) were studied by lymphoscintigraphy and biopsy in 100 breast cancer patients to assess: (i) if a deep injection can visualize the IMNs in a high percentage of cases (ii) to determine how often IMNs are metastatic. More than 60% of patients showed IMNs uptake. Surgical sampling proved simple and risks insignificant. Five positive IMN cases migrated from NO/N1 to N3, prompting treatment modification. It is unclear whether this additional information can lead to better survival.

427 Poster Could radiotherapy to the internal mammary and medial supra clavicular lymph node chain (IM-MS) be cost-effective?

427 Poster Could radiotherapy to the internal mammary and medial supra clavicular lymph node chain (IM-MS) be cost-effective?

Internal mammary sentinel node biopsy for breast cancer: Is it practicable and relevant? (Review)

Sentinel lymph node (SLN) biopsy is a useful way of assessing axillary nodal status and obviates unnecessary axillary lymph node dissection for patients with node-negative breast cancer. However, SLN can also be located in the internal mammary lymph node (IMN) chain or elsewhere. The practicability and relevance of internal mammary SLN is reviewed and discussed. Axillary and IMN status have similar predictive value for survival, and the involvement of IMNs has prognostic value for both axillary node-negative and node-positive patients. Although parasternal recurrence is fortunately rare after modified radical mastectomy or breast conserving surgery, if left untreated it develops not infrequently as a clinically evident disease in patients with histologic involvement of IMNs. Internal mammary SLNs can be identified by means of lymphoscintigraphy and gamma-detection probe after peritumoral injection of radioisotopes. A positive internal mammary SLN biopsy would be an indication for internal mammary radiotherapy as well as adjuvant systemic treatment. However, the reported incidence of positive internal mammary SLNs is still lower than expected, because the spread of radioisotope activity is not synonymous with nodal positivity. Internal mammary SLN biopsy is considered to be still in the investigative stage. More data are needed on the correction of a internal mammary SLN and pathologic positivity, so that further clinical investigation is clearly warranted.

Influence of systemic therapy on pulmonary function tests in breast cancer patients irradiated to the internal mammary and medial supraclavicular lymph node chain

Influence of systemic therapy on pulmonary function tests in breast cancer patients irradiated to the internal mammary and medial supraclavicular lymph node chain

Quality assurance in the EORTC phase III randomised trial 22922/10925 investigating the role of internal mammary and medial supraclavicular lymph node chain irradiation in stage I–III breast cancer: A report on the dummy run

Quality assurance in the EORTC phase III randomised trial 22922/10925 investigating the role of internal mammary and medial supraclavicular lymph node chain irradiation in stage I–III breast cancer: A report on the dummy run

Management of Stage MB Breast Cancer

Systemic treatments with hormones and/or chemotherapy attained outstanding success in producing objective regressions of local and distant metastases of breast cancer. With these demonstrations, similar therapies were employed in the adjuvant setting for stage II patients resulting in improved disease-free and overall survival (1,2). For locally advanced disease, systemic treatments caused substantial shrinkage of unresectable primary tumors (3,4). Because of the poor prognosis of stage III breast cancer, a positive approach to its management has been neglected or at least variable. This has been associated, in part, with the changing of staging systems of breast cancer. Further confusion occurred with clinical trials that incorporated stages IIB and III breast cancer. For clarification in this report, reference will be made to stage IIIB breast cancer (5,6). Stage IIIB breast cancer consists of tumors of any size with direct extension to the chest wall or skin (T4) with axillary node involvement (N1 and N2), but not including internal mammary chain or supraclavicular nodes. Inflammatory carcinoma (T4d) is also included. Distant metastases are not present (5,6). Data for the staging system of the American Joint Committee on Cancer in 1992 reported the 5-year survival of stage IIIB breast cancer was approximately 48% (6).