Radiotherapy
An analysis of the incidental irradiation to the axillary levels Ⅰ-Ⅲ lymph node during radiotherapy after breast conserving surgery
Xiaodong Gu, Xin Qi, Qingan Wang, Xianshu Gao, B Zhao, Xiaomei Li, Hongzhen Li, Ling Xin, Yinhua Liu
Published 2018-06-25
Cite as Chin J Radiol Med Prot, 2018, 38(6): 434-438. DOI: 10.3760/cma.j.issn.0254-5098.2018.06.007
Abstract
ObjectiveTo evaluate the incidental irradiation to the axillary levels Ⅰ, Ⅱ and Ⅲ during the whole breast radiotherapy after breast conserving surgery (BCS) without axillary lymph node dissection (ALND) in breast cancer (BC) patients.
MethodsA retrospective analysis was performed on the consecutive 42 cases of T1-2N0M0 stage BC patients with sentinel lymphnode biopsy (SLNB) and BCS but without ALND. The axillary lymph nodes of Ⅰ, Ⅱ and Ⅲ were delineated according to RTOG atlas guideline. Three radiotherapy plans including conventional tangential field (CTF), three-dimensional conformal radiotherapy (3D-CRT) and forward-planned intensity-modulated radiotherapy (IMRT) for whole breast irradiation were devised for each case. The Prescription dose was 50 Gy per 25 fractions. Doses to axillary levels (Ⅰ-Ⅲ) were evaluated.
ResultsThe mean doses delivered to axillary by the three techniques (CTF, 3D-CRT and IMRT) were (40.1±6.8), (35.4±8.3), (32.9±7.0) Gy for level Ⅰ (F=10.269, P<0.05), (33.2±7.1), (30.6±6.7), (30.4±7.0) Gy for level Ⅱ (P>0.05) and (9.6±6.8), (6.4±4.5), (5.2±3.7) Gy for level Ⅲ (F=8.377, P<0.05), respectively. V50(volume receiving 50 Gy) for the three techniques were 21.3%, 27.6%, 9.6% for level Ⅰ (F=13.161, P<0.05), 12.9%, 15.9%, 8.3% for level Ⅱ(F=2.750, P<0.05)and 0.4%, 0.1% and 0% for level Ⅲ(P>0.05), respectively.
ConclusionsThe doses coverage to axillary levels Ⅰ-Ⅲ were all limited in the three techniques. Therefore, it is necessary to assess the risk of axillary lymph node metastasis adequately to develop individualized radiotherapy plans.
Key words:
Breast neoplasms/radiotherapy; Conventional tangential field; Three-dimensional conformal radiotherapy; Intensity-modulated radiotherapy; Axillary lymph node
Contributor Information
Xiaodong Gu
Department of Breast Radiation Oncology, Center of Radiation Therapy, Shanxi Cancer Hospital, Taiyuan 030013, China
Xin Qi
Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
Qingan Wang
Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
Xianshu Gao
Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
B Zhao
Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
Xiaomei Li
Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
Hongzhen Li
Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
Ling Xin
Department of General Surgery, Peking University First Hospital, Beijing 100034, China
Yinhua Liu
Department of General Surgery, Peking University First Hospital, Beijing 100034, China
