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Objective:To compare the differences of postoperative clinical target volume of internal mammary lymph node (CTV ImlN) by different delineation methods, and to explore the reasonable method of CTV ImlN delineation after internal mammary lymph node dissection (ImlND). Methods:A total of 20 breast cancer patients who had undergone modified radical mastectomy (MRM) with ImlND on the affected side and had complete preoperative and postoperative CT images were selected. The CTV (CTV pr-I, CTV pr-a) of both sides of ImlN were delineated on preoperative CT images according to RTOG guideline. On postoperative CT images, three different methods including deformation image registration (DIR) method, visual contrast method and precise measurement method, were employed to delineate the postoperative CTV ImlN of the affected side. The targets were named as CTV DIR, CTV V and CTV M, respectively. The central displacement, target volume, degree of inclusion (DI) and conformity index (CI) of CTV pr-a, CTV V, CTV M and CTV DIR were compared. Results:The central displacement of CTV V, CTV M and CTV DIR from CTV pr-a was 2.17 cm, 1.44 cm and 1.25 cm, respectively. The target volume of CTV pr-a, CTV pr-I, CTV V, CTV M and CTV DIR was 2.10 cm 3, 2.17 cm 3, 2.04 cm 3, 1.88 cm 3 and 2.07 cm 3 respectively. There was no significant difference in the target volume (all P>0.05). The CI values of CTV V-CTV pr-a and CTV M-CTV pr-a were both 0.16, and that of CTV DIR-CTV pr-a was 0.43. The CI value of CTV DIR was significantly higher than those of CTV V and CTV M (both P<0.01). The DI values of CTV V-CTV pr-a, CTV M-CTV pr-a and CTV DIR-CTV pr-a were 0.26, 0.24 and 0.58, respectively. The DI value of CTV DIR was significantly higher than those of CTV V and CTV M (both P<0.01). Conclusions:It is difficult to accurately delineate the CTV ImlN for patients after ImlND. However, the spatial position fitness of the target region delineated by DIR method is better than those by visual contrast and precise measurement methods.
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Objective:To explore the application value of skin lead marker combined with iSCOUT image-guided positioning system in monitoring and correcting the setup error of intensity-modulated radiotherapy (IMRT) for breast cancer and calculate the PTV margin, aiming to provide reference for clinical practice.Methods:25 breast cancer patients treated with IMRT after modified radical mastectomy in Fujian Medical University Union Hospital from April to August 2019 were enrolled in this study. The skin lead marker combined with iSCOUT image-guided positioning system was employed for image-guided positioning based on the gold standard registration algorithm. Initial setup errors on the x (lateral), y (craniocaudal) and z (anteroposterior) axis and residual errors after the position correction were recorded and analyzed. The effect of the errors before and after image-guided correction upon the plan dose was compared and the reasonable PTV margin was calculated.Results:25 patients received 150 times of positioning verification using skin lead marker combined with iSCOUT image-guided positioning system. The absolute residual errors on the x-, y-and z-axis were (1.53±0.96), (1.30±0.99) and (1.34±0.92) mm, significantly smaller than the initial setup errors of (2.63±2.12), (2.41±2.45) and (3.07±2.77) mm (all P<0.001). The percentage of dose deviation due to residual errors was also smaller than that of the initial errors. Significant differences were observed in D 98%, D 2%, D max of PTV, D max of the heart, D max of the healthy breast, and D mean of the affected lung and both lungs. The percentage deviation from the original plan was decreased from 2.18%, 3.19%, 10.66%, 8.75%, 48.21%, 10.50%, and 3.66% to 0.38%, 0.23%, 2.31%, 0.04%, 13.78%, 6.35% and 0.41%, respectively (all P<0.05). PTV margins on the x-, y-and z-axis after correction were calculated as 1.87, 1.75 and 1.69 mm, respectively. Conclusion:It is feasible and valuable to apply the skin lead marker combined with iSCOUT image-guided positioning system in the positioning verification and correction of breast cancer radiotherapy position, providing novel reference for clinical PTV margin.
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Objective:To evaluate the effect of prophylactic irradiation of internal mammary lymph nodes in patients with breast cancer in this Meta-analysis.Methods:CNKI, Wanfang Medical network, CBM, PubMed, EMBASE and Web of Science were searched by computer. The controlled clinical studies comparing whether or not internal mammary lymph node irradiation as an intervention were included and the quality of the included literature was evaluated according to Newcastle-Ottawa Scale (NOS). RevMan 5.3 software and Stata 14 software were used for Meta-analysis.Results:A total of 11 original articles were included, and 13 181 patients were included for Meta-analysis. There was no statistically significant difference in the overall survival (OS) between patients with and without internal mammary lymph node irradiation ( P=0.490). The subgroup analysis using the date of treatment and the degree of risk in the enrolled population as criteria showed that 5-year OS was significantly increased after internal mammary area irradiation in high-risk stage Ⅱ-Ⅲ patients (N+ , T 3-T 4 stage) with the date of treatment of after 2000( P=0.003, 0.006). Compared with patients without internal mammary area irradiation, internal mammary irradiation significantly increased the 5-year disease-free survival (DFS)( P<0.001). Conclusion:Under the modern radiotherapy technology, internal mammary lymph node irradiation improves the DFS of patients, and may bring OS benefits to high-risk stage Ⅱ-Ⅲ breast cancer patients (N+ , T 3-T 4 stage).
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Objective:To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence.Methods:Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results:With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval o F>12 months had a lower sLR rate. Patients with recurrence interval o F>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60 Gy vs.>60 Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%( P=0.061) with tumor bed dose ≤60 Gy and>60 Gy, respectively. Conclusions:Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60 Gy, and it should be above 60 Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.
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Objective:To evaluate the clinical efficacy of radiotherapy in the treatment of extracranial metastatic breast cancer, and to investigate the significance and prognostic factors of whole-lesion radiotherapy (WLRT).Methods:Clinical data of 85 patients with extracranial metastatic breast cancer treated with radiotherapy between 2014 and 2019 were retrospectively analyzed. Thirty-six patients were assigned into the WLRT group and 49 in the non-WLRT group. The local control (LC), progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan- Meier method, log-rank test and univariate prognostic analysis. Cox proportional hazards model was used for multivariate prognostic analysis. Results:The median follow-up time was 26.7 months. The 2-year LC, PFS, OS rates were 77%, 26%, 77%, respectively. The 2-year LC (91% vs. 67%, P=0.001), PFS (47% vs. 8%, P<0.001), OS rates (84% vs. 71%, P=0.010) in the WLRT group were significantly higher than those in the non-WLRT group, respectively. Multivariate analysis demonstrated that WLRT was an independent favorable prognostic factor for the LC, PFS and OS. Furthermore, bone metastasis alone was associated with improved LC and positive hormone receptor status was correlated with improved OS. Conclusions:WLRT has the potential to prolong the survival of patients with extracranial metastatic breast cancer. The patients with bone metastases alone obtain better LC, whereas those with negative hormone receptor status has worse OS.
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Objective In this study,the deep learning algorithm and the commercial planning system were integrated to establish and validate an automatic segmentation platform for clinical target volume (CTV) and organs at risk (OARs) in breast cancer patients.Methods A total of 400 patients with left and right breast cancer receiving radiotherapy after breast-conserving surgery in Cancer Hospital CAMS were enrolled in this study.A deep residual convolutional neural network was used to train CTV and OARs segmentation models.An end-to-end deep learning-based automatic segmentation platform (DLAS) was established.The accuracy of the DLAS platform delineation was verified using 42 left breast cancer and 40 right breast cancer patients.The overall Dice Similarity Coefficient (DSC) and the average Hausdorff Distance (AHD) were calculated.The relationship between the relative layer position and the DSC value of each layer (DSC_s) was calculated and analyzed layer-by-layer.Results The mean overall DSC and AHD of global CTV in left/right breast cancer patients were 0.87/0.88 and 9.38/8.71 mm.The average overall DSC and AHD range for all OARs in left/right breast cancer patients were ranged from 0.86 to 0.97 and 0.89 to 9.38 mm.The layer-by-layer analysis of CTV and OARs reached 0.90 or above,indicating that the doctors were only required to make slight or no modification,and the DSC_s ≥ 0.9 of CTV automatic delineation accounted for approximately 44.7％ of the layers.The automatic delineation range for OARs was 50.9％-89.6％.For DSC_s ＜ 0.7,the DSC_s values of CTV and the regions of interest other than the spinal cord were significantly decreased in the boundary regions on both sides (layer positions 0-0.2,and 0.8-1.0),and the level of decrease toward the edge was more pronounced.The spinal cord was delineated in a full-scale manner,and no significant decrease in DSC_s was observed in a particular area.Conclusions The end-to-end automatic segmentation platform based on deep learning can integrate the breast cancer segmentation model and achieve excellent automatic segmentation effect.In the boundary areas on both sides of the superior and inferior directions,the consistency of the delineation decreases more obviously,which needs to be further improved.
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Objective To analyze the differences in the treatment patterns,clinical characteristics,treatment outcomes and prognostic factors between breast cancer patients with ductal carcinoma in situ (DCIS) and ductal carcinoma in situ with microinvasion (DCIS-MI).Methods Clinical data of 866 female patients including 631 DCIS cases and 235 DCIS-MI cases treated in our institution between 1999 and 2013 were retrospectively analyzed.The local control (LC),disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival analysis.The prognostic factors were identified by Log-rank test.Results Similar LC,DFS and OS rates were obtained between two groups (all P＞ O.05).The univariate analysis demonstrated that Her-2-positive patients had worse OS and DFS than Her-2-negative counterparts.Patients undergoing breast-conserving surgery without radiotherapy had lower LC and DFS rates compared with those receiving radical mastectomy.Conclusions DCIS and DCIS-MI patients have similar clinical prognosis in terms of OS,LC and DFS.Her-2 positive is an unfavorable prognostic factor for DFS and OS.The LC and DFS rates in the breast-conserving surgery alone group are worse than those in the mastectomy group.
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Objective@#To investigate the current status of breast reconstruction surgery in China and analyze the specific views of Chinese doctors on the relationship between radiotherapy and breast reconstruction surgery.@*Methods@#A total of 110 medical institutions nationwide with more than 200 cases of breast cancer surgery yearly were selected into this questionnaire survey. The questionnaire survey included basic information of the surgeons and their hospitals, information of breast cancer surgeries in 2017, types of reconstruction surgery and specific views on the relationship between radiotherapy and reconstruction surgery.@*Results@#In total, 110 hospitals participated in the survey, 96(87.3%) had undergone breast reconstruction surgery. Reconstruction with implants accounted for 65.7% of the total reconstruction surgery and the proportion of autologous reconstruction was 20.1%. For patients who probably required postoperative radiotherapy, the preferred surgical procedure in the surveyed hospitals was implant based reconstruction surgery. For those who were confirmed to receive postoperative radiotherapy or had undergone radiotherapy after total mastectomy, autologous tissue reconstruction was recommended. Postoperative radiotherapy was a negative factor for immediate breast reconstruction, and most hospitals believed that radiotherapy exerted slight effect on surgery. The proportion of delay-immediate breast reconstruction reached 66% and 86% of hospitals preferred to replace with the prosthesis at 6 months after radiotherapy. Patients with local recurrence after breast-conserving surgery could also receive immediate reconstruction and implant reconstruction was the preferred surgical procedure.@*Conclusions@#The proportion of breast reconstruction in China is relatively low and Chinese doctors still lack of technical mastery. In the face of conflict with radiotherapy, the regime selected by Chinese doctors is not in accordance with those recommended by the guideline and consensus, prompting that more professional training should be delivered for Chinese doctors to further promote the development of breast reconstruction in China.
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Objective@#To investigate the dosimetric characteristics of conventional two-dimensional radiotherapy of the chest wall, supra-and infra-clavicular regions, and the incidental irradiation dosage of the internal mammary region after modified mastectomy in breast cancer patients.@*Methods@#Clinical data of 20 breast cancer patients including 10 left and 10 right cases who received radiotherapy after modified mastectomy between 2015 and 2016 were retrospectively analyzed. All patients received irradiation to the chest wall, supra-and infraclavicular regions at a prescription dose of 43.5 Gy in 15 fractions with conventional technique. One anterior-posterior (AP) photon field irradiation was delivered for the supra-and infra-clavicular regions, and one electron field for the chest wall. The supra-and infraclavicular regions were re-planned by using two AP/PA fields and the doses of organ at risk were evaluated.@*Results@#With conventional radiotherapy, the D90 of the supra-and infra-clavicular regions were more than 39.15 Gy (EQD2≥45 Gy) in 17 patients (85%), and the median D90 of the chest wall was 35.38 Gy. The median dose of incidental internal mammary region was 13.65 Gy. Patients with lower body mass index (BMI) received higher D90 in both supra-and infra-clavicular and chest wall irradiation (P=0.039, 0.347).@*Conclusions@#Irradiation at D90 of 39.15 Gy to the supra-and infra-clavicular regions with AP/PA fields can meet the prescription dose requirement of ≥90% in most cases and does not increase the irradiation dose to normal tissues. The dose distribution of one electron field of the chest wall is poor. Incidental internal mammary region can be irradiated at a limited dosage. BMI is an influencing factor for dose distribution.
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Objective@#To compare the efficacy between hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer by a meta-analysis.@*Methods@#The controlled clinical trials of comparing hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer were searched from PubMed, EMbase, Cochrane Library, Wanfang database, VIP, CNKI, and CBM databases. The obtained data were analyzed using RevMan 5.3 and Stata 14.0 software. The differences between two groups were estimated by calculating the odds ratio (OR) with 95% confidence interval (CI).@*Results@#A total of 19 controlled clinical trials involving 2652 post-mastectomy breast cancer patients were selected in this meta-analysis according to the inclusion and exclusion criteria. The meta-analysis results demonstrated that no statistical significance was observed in the tumor-free survival (OR=1.10, 95%CI: 0.78-1.56, P=0.59), overall survival (OR=1.18, 95%CI: 0.92-1.53, P=0.19), locoregional recurrence (OR=1.01, 95%CI: 0.68-1.51, P=0.96), distant metastasis (OR=1.14, 95%CI: 0.82-1.59, P=0.43), skin toxicity (OR=1.01, 95%CI=0.80-2.16, P=0.96), cardiac toxicity (OR=1.17, 95%CI: 0.71-1.93, P=0.53) and pulmonary toxicity (OR=0.78, 95%CI: 0.44-1.37, P=0.38) between two groups.@*Conclusions@#Hypofractionated radiotherapy and conventionally fractionated radiotherapy post-mastectomy yield similar clinical efficacy, both of which are safe and efficacious radiotherapy patterns. However, the findings remain to be validated by large-scale randomized clinical trials with long-term follow-up of the advanced stage complications.
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Objective To compare the clinical efficacy between breast-conserving surgery (BCS) plus radiotherapy (RT) and modified mastectomy in patients with stage Ⅰ breast cancer in clinical setting.Methods Clinical data of 6 137 patients diagnosed with pT1-2N0 breast cancer from 1999 to 2014 were retrospectively reviewed.Among them,1 296 patients received BCS plus RT (BCS group) and 4 841 cases underwent modified mastectomy alone (modified mastectomy group).Kaplan-Meier analysis was used for survival analysis.Log-rank test,single factor analysis and Cox's proportional hazards regression model were performed.The results were further confirmed with the propensity score-matching (PSM) method.Results Within a median follow-up period of 55.2 months (range,1-222 months),the 5-year locoregional recurrence-free survival (LRFS),distant metastasis-free survival (DMFS),disease-free survival (DFS) and overall survival (OS) were 96.3％,93.7％,91.9％ and 96.9％,respectively.In the BCS plus RT group,the 5-year DMFS (96.9％ vs.92.9％,P＜0.001),DFS (94.9％ vs.91.2％,P=0.005) and OS (99.1％ vs.96.4％,P=0.001) were significantly higher than those in the mastectomy group.Multivariate analysis revealed that postoperative RT was an influencing factor of DMFS (P=0.003,HR=0.621;95％CI:0.455-0.849) and OS (P=0.036;HR=0.623;95％CI:0.401-0.969).For 1 252 pairs of patients matched by PSM,the 5-year OS (99.1％ vs.96.1％,P=0.001),DMFS (97.0％ vs.92.2％,P＜0.001) and DFS (95.3％ vs.90.2％,P=0.001) in the BCS plus RT group were significantly higher compared with those in the mastectomy group.Conclusion The long-term clinical prognosis of patients with stage Ⅰ breast cancer in the BCS plus RT group is better than that in the mastectomy group.BCS plus RT should be recommended for patients with stage Ⅰ breast cancer.
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Objective To evaluate the effect of surgery-radiotherapy interval (SRI) on clinical prognosis of locally advanced stage c Ⅱ-Ⅲ breast cancer patients treated with neoadjuvant chemtherapy and modified radical mastectomy.Methods Clinical data of 1 087 breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy from 11 hospitals in China were retrospectively analyzed.The optimal threshold value of SRI upon clinical prognosis was determined by maxstat method.The effect of SRI on clinical prognosis was evaluated by using multivariate Cox regression analysis and propensity score matching (PSM).Results The median follow-up time was 72.9 months.The 5-year disease-free survival (DFS) and overall survival (OS) rates were 68.1％ and 81.8％.All patients were divided into SRI ≤18 weeks (n=917) and SRI＞ 18 weeks groups (n=170).Multivariate Cox regression analysis demonstrated that hormone receptor status (P＜0.001),pathological T stage (P＜0.001),pathological N stage (P＜0.001) and SRI (P=0.023) were independent influencing factors of DFS.Hormone receptor status (P=0.013),pathological T stage (P=0.006),pathological N stage (P＜0.001),endocrine therapy (P=0.013) and SRI (P=0.001) were significantly associated with OS.After balancing the clinical and pathological factors with PSM,patients with SRI＜ 18 weeks had superior DFS and OS to those with SRI＞ 18 weeks.Conclusions SRI affects the clinical prognosis of locally advanced breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy.Radiotherapy should be performed within 18 weeks after mastectomy.
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Objective To investigate the dosimetric characteristics of conventional two-dimensional radiotherapy of the chest wall,supra-and infra-clavicular regions,and the incidental irradiation dosage of the internal mammary region after modified mastectomy in breast cancer patients.Methods Clinical data of 20 breast cancer patients including 10 left and 10 right cases who received radiotherapy after modified mastectomy between 2015 and 2016 were retrospectively analyzed.All patients received irradiation to the chest wall,supra-and infraclavicular regions at a prescription dose of 43.5 Gy in 15 fractions with conventional technique.One anterior-posterior (AP) photon field irradiation was delivered for the supra-and infra-clavicular regions,and one electron field for the chest wall.The supra-and infraclavicular regions were re-planned by using two AP/PA fields and the doses of organ at risk were evaluated.Results With conventional radiotherapy,the D90 of the supra-and infra-clavicular regions were more than 39.15 Gy (EQD2 ≥45 Gy) in 17 patients (85％),and the median D90 of the chest wall was 35.38 Gy.The median dose of incidental internal mammary region was 13.65 Gy.Patients with lower body mass index (BMI) received higher D90 in both supra-and infra-clavicular and chest wall irradiation (P=0.039,0.347).Conclusions Irradiation at D90 of 39.15 Gy to the supra-and infra-clavicular regions with AP/PA fields can meet the prescription dose requirement of ≥90％ in most cases and does not increase the irradiation dose to normal tissues.The dose distribution of one electron field of the chest wall is poor.Incidental internal mammary region can be irradiated at a limited dosage.BMI is an influencing factor for dose distribution.
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Objective To compare the efficacy between hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer by a meta-analysis.Methods The controlled clinical trials of comparing hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer were searched from PubMed,EMbase,Cochrane Library,Wanfang database,VIP,CNKI,and CBM databases.The obtained data were analyzed using RevMan 5.3 and Stata 14.0 software.The differences between two groups were estimated by calculating the odds ratio (OR) with 95％ confidence interval (CI).Results A total of 19 controlled clinical trials involving 2652 post-mastectomy breast cancer patients were selected in this meta-analysis according to the inclusion and exclusion criteria.The meta-analysis results demonstrated that no statistical significance was observed in the tumor-free survival (OR =1.10,95 ％ CI:0.78-1.56,P =0.59),overall survival (OR =1.18,95 ％ CI:0.92-1.53,P =0.19),locoregional recurrence (OR=1.01,95％CI:0.68-1.51,P=0.96),distant metastasis (OR=1.14,95％CI:0.82-1.59,P=0.43),skin toxicity (OR=1.01,95％CI=0.80-2.16,P=0.96),cardiac toxicity (OR=1.17,95％CI:0.71-1.93,P=0.53) and pulmonary toxicity (OR=0.78,95％CI:0.44-1.37,P=0.38) between two groups.Conclusions Hypofractionated radiotherapy and conventionally fractionated radiotherapy post-mastectomy yield similar clinical efficacy,both of which are safe and efficacious radiotherapy patterns.However,the findings remain to be validated by large-scale randomized clinical trials with long-term follow-up of the advanced stage complications.
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In recent years,along with the clinical exploration and application of magnetic resonance simulation localization and radiotherapy equipment,more and more studies have been performed to focus on the excellent ability of MRI in identifying soft tissues,aiming to explore the potential application value of magnetic resonance imaging (MRI) in radiotherapy for breast cancer patients.In this article,the research progress on MRI in radiotherapy after breast-conserving surgery was reviewed to provide certain ideas and references for subsequent research.
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Objective To investigate the setup errors and influencing factors of the whole breast intensity-modulated radiotherapy (IMRT) after breast-conserving surgery,and to identify the margins from clinical target volume (CTV) to planning target volume (PTV).Methods Thirty patients with left-sided (n=15) or right-sided breast cancer (n=15) receiving whole breast hypofractionated IMRT with breast board immobilization after breast-conserving surgery in Cancer Hospital from 2016 to 2017 were enrolled.The kilo-voltage cone-beam computed tomography (CBCT) was used to compare the errors of planning CT and treatment unit and determine the setup errors.The margins from CTV to PTV were calculated.The setup errors under different conditions were statistically compared by t-test.Results A total of 151 sets of CBCT images were taken in the whole cohort,(5.0± 1.3) sets per patient on average.The setup errors in the x-axis (left-right direction),y-axis (cranial-caudal direction) and z-axis (anterior-posterior direction) were (2.2± 1.7) mm,(3.1±2.5) mm and (3.3±2.3) mm,respectively.The margins from CTV to PTV were 6.39 mm,10.00 mm and 8.57 mm,respectively.The setup error in anterior-posterior direction in the first week was (3.7±2.5) mm,significantly larger than (2.6±1.6) mm in the following week (P=0.002).The setup error of the patients with overweight or obesity was (3.9±2.6) mm,significantly higher than (2.9±2.0) mm in those with normal weight in the z-axis direction (P=0.033).Conclusion The margins from CTV to PTV are recommended to be ranged from 6 to 10 mm during hypofractionated whole breast IMRT with breast board immobilization after breast-conserving surgery.More frequent imaging verification should be applied in the first week of IMRT.
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Objective To investigate and analyze the reasons for the omission of adjuvant radiotherapy after breast-conserving surgery (BCS) in patients with breast cancer.Methods The clinicopathologial characteristics and socioeconomic data of 55 breast cancer patients undergoing BCS without postoperative adjuvant radiotherapy in our hospital from 2012 to 2016 were retrospectively analyzed.Results Among the 55 patients who did not receive radiotherapy,25 patients were due to low local recurrence risk,12 patients were due to economic or family reasons,12 patients were due to fear of adverse reactions of radiotherapy,and 5 patients were not recommended by primary physicians for radiotherapy.In addition,3 cases with multiple distant metastases and 3 cases with concomitant thyroid cancer didn't received radiotherapy.Conclnsions Low risk local recurrence is the main reason for the omission of adjuvant radiotherapy,followed by the fear of radiation-induced toxicity and poor financial support.Patient education and medical insurance may improve the adjuvant radiotherapy compliance.
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Objective@#To investigate the influencing factors of the dose coverage of unplanned internal mammary lymph node (IMN) irradiation in patients receiving chemotherapy after mastectomy.@*Methods@#Clinical data of 138 patients receiving radiotherapy in the upper and lower lymph node drainage area of the thoracic wall and clavicle [three-dimensional conformal radiotherapy (3DCRT), field-in-field forward intensity-modulated radiotherapy (F-IMRT) or inverse IMRT (I-IMRT)] were retrospectively analyzed. The IMN was delineated according to the Radiation Therapy Oncology Group (RTOG) criteria. The unplanned irradiation dose of the IMN was obtained. The correlation between the IMN irradiation dose, clinical characteristics and specific parameters of radiotherapy during the unplanned irradiation was statistically analysed.@*Results@#The mean dose of unplanned IMN irradiation was 32.85 Gy (range: 2.76-50.93 Gy). In total, 7.3% of breast cancer patients obtained the therapeutic dose of≥ 45 Gy. Body weight, body mass index (BMI), body surface area (BSA) and thoracic transverse diameter (DT) were lower, whereas the planning target volume of IMN (VIMN) included in the chest wall PTV (IMNin) and the ratio of IMNin to VIMN were higher compared with those of their counterparts with insufficient therapeutic dose. Multivariate regression analysis demonstrated that body weight, thoracic anteroposterior diameter (DAP), DT, RIMNin and PTV volume were the influencing factors of the dose coverage of unplanned IMN irradiation (P=0.000, 0.000, 0.001, 0.000 and 0.034).@*Conclusions@#For patients receiving chemotherapy after mastectomy, the dose coverage significantly varies when the IMN is the unplanned target. Partial patients achieve the therapeutic dose. The dose coverage of unplanned IMN irradiation is influenced by physical characteristics, anatomical features and technical parameters of radiotherapy, which should be emphasized during the study design and result analysis.
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Radiotherapy is an important part of the postoperative adjuvant therapy of breast cancer. Radiation-induced brachial plexopathy (RIBP) of postoperative radiotherapy severely reduces the quality of life of breast cancer patients. In this article, the general situation, mechanism, diagnosis, risk factors, treatment and preventive measures of RIBP were reviewed.
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For patients with positive sentinel lymph nodes, axillary lymph node dissection ( ALND) is the conventional treatment. However, ALND can cause seroma, the upper limb dysfunction, edema and alternative complications. Z0011, IBCSG 23-01 and AMAROS phaseⅢrandomized controlled clinical trials recommend ALND after sentinel lymph node biopsy in N0 patients, which provides a novel option for axillary lymph node treatment, but also brings new challenges to the decision of adjuvant radiotherapy. In this paper, based upon these three clinical trials and latest literatures related to the risk of axillary lymph node metastasis and recurrence, the therapeutic strategies including surgery and adjuvant radiotherapy for patients with positive sentinel lymph nodes are reviewed and summarized.