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1.
Article in Chinese | WPRIM | ID: wpr-910527

ABSTRACT

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.

2.
Article in Chinese | WPRIM | ID: wpr-910490

ABSTRACT

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).

3.
Article in Chinese | WPRIM | ID: wpr-818381

ABSTRACT

Breast cancer is currently among the most frequently occurring malignant tumors in female patients, with more than one million female patients suffering from breast cancer worldwide each year. Postoperative radiotherapy for breast cancer treatment is an important treatment option for patients with early breast cancer, which could significantly reduce the mortality and recurrence rate of breast cancer patients. Intramammary lymph node irradiation after radical mastectomy could improve the survival of patients with early breast cancer is currently be of controversy. This study mainly reviews the research progress of internal mammary lymph node radiotherapy, including the techniques, dose selection, survival, and adverse reaction-related reports.

4.
Chinese Journal of Oncology ; (12): 801-804, 2019.
Article in Chinese | WPRIM | ID: wpr-801323

ABSTRACT

Internal mammary lymph node (IMLN) metastasis forms the part of the N-staging of breast cancer, and affects the treatment program and prognosis. At present, IMLN metastasis is clinically diagnosed by anatomical imaging, functional imaging and postoperative pathology. Anatomical imaging includes ultrasound, CT and MRI. Functional image includes positron emission computed tomography (PET-CT), PET-MRI, single photon emission computed tomography (SPECT) and SPECT-CT. Because of the special location of the internal mammary region and the complex anatomical structure around it, the imaging diagnosis rate and pathological diagnosis rate of IMLN are often different. Therefore, it is important to identify the relevant factors of IMLN metastasis for guiding the local treatment of internal mammary region, including the scope of surgery and radiotherapy.

5.
Cancer Research and Treatment ; : 1500-1508, 2019.
Article in English | WPRIM | ID: wpr-763211

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the treatment outcomes of radiotherapy (RT) for breast cancer with ipsilateral supraclavicular (SCL) and/or internal mammary (IMN) lymph node involvement. MATERIALS AND METHODS: A total of 353 patients from 11 institutions were included. One hundred and thirty-six patients had SCL involvement, 148 had IMN involvement, and 69 had both. All patients received neoadjuvant systemic therapy followed by breast-conserving surgery or mastectomy, and postoperative RT to whole breast/chest wall. As for regional lymph node irradiation, SCL RT was given to 344 patients, and IMN RT to 236 patients. The median RT dose was 50.4 Gy. RESULTS: The median follow-up duration was 61 months (range, 7 to 173 months). In-field progression was present in SCL (n=20) and/or IMN (n=7). The 5-year disease-free survival (DFS) and overall survival rates were 57.8% and 75.1%, respectively. On multivariate analysis, both SCL/IMN involvement, number of axillary lymph node ≥ 4, triple-negative subtype, and mastectomy were significant adverse prognosticators for DFS (p=0.022, p=0.001, p=0.001, and p=0.004, respectively). Regarding the impact of regional nodal irradiation, SCL RT dose ≥ 54 Gy was not associated with DFS (5-year rate, 52.9% vs. 50.9%; p=0.696) in SCL-involved patients, and the receipt of IMN RT was not associated with DFS (5-year rate, 56.1% vs. 78.1%; p=0.099) in IMN-involved patients. CONCLUSION: Neoadjuvant chemotherapy followed by surgery and postoperative RT achieved an acceptable in-field regional control rate in patients with SCL and/or IMN involvement. However, a higher RT dose to SCL or IMN RT was not associated with the improved DFS in these patients.


Subject(s)
Breast Neoplasms , Breast , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Humans , Lymph Nodes , Mastectomy , Mastectomy, Segmental , Multivariate Analysis , Radiotherapy , Retrospective Studies , Survival Rate
6.
Article in English | WPRIM | ID: wpr-761002

ABSTRACT

PURPOSE: Internal mammary lymph node (IMN) involvement is associated with poor prognosis in breast cancer. This study investigated the treatment outcomes of initial clinically IMN-positive breast cancer patients who received adjuvant radiotherapy (RT), including IMN irradiation, following primary breast surgery. MATERIALS AND METHODS: We retrospectively reviewed data of 95 breast cancer patients with clinically detected IMNs at diagnosis treated with surgery and RT between June 2009 and December 2015. Patients received adjuvant RT to the whole breast/chest wall and regional lymph node (axillary, internal mammary, and supraclavicular) areas. Twelve patients received an additional boost to the IMN area. RESULTS: The median follow-up was 43.2 months (range, 4.5 to 100.5 months). Among 77 patients who received neoadjuvant chemotherapy, 52 (67.5%) showed IMN normalization and 19 (24.6%) showed a partial response to IMN. There were 3 and 24 cases of IMN failure and any recurrence, respectively. The 5-year IMN failure-free survival, disease-free survival (DFS), and overall survival (OS) were 96%, 70%, and 84%, respectively. IMN failure-free survival was significantly affected by resection margin status (97.7% if negative, 87.5% for close or positive margins; p = 0.009). All three patients with IMN failure had initial IMN size ≥1 cm and did not receive IMN boost irradiation. The median age of the three patients was 31 years, and all had hormone receptor-negative tumors. CONCLUSION: RT provides excellent IMN control without the support of IMN surgery. Intensity-modulated radiotherapy, including IMN boost for breast cancer patients, is a safe and effective technique for regional lymph node irradiation.


Subject(s)
Breast Neoplasms , Breast , Diagnosis , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Humans , Lymph Nodes , Prognosis , Radiotherapy , Radiotherapy, Adjuvant , Radiotherapy, Intensity-Modulated , Recurrence , Retrospective Studies
7.
Article in Chinese | WPRIM | ID: wpr-807140

ABSTRACT

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.

8.
Article in Chinese | WPRIM | ID: wpr-666186

ABSTRACT

Objective To explore the dosimetric variance in incidental irradiation to the internal mammary nodes among inverse intensity-modulated radiotherapy (I-IMRT), forward intensity-modulated radiotherapy (F-IMRT),and three-dimensional conformal radiotherapy (3DCRT) after breast-conserving surgery,and to provide a basis for deciding whether to spare the internal mammary nodes in clinical treatment. Methods A total of 84 patients undergoing breast-conserving surgery were enrolled as subjects. The internal mammary nodes in the first three intercostal spaces were contoured. Three radiotherapy plans were designed for each patient. The internal mammary nodes were not included in the planning target volume. Comparison was made among the three plans. The results were compared using Wilcoxon signed rank test. Results The I-IMRT, F-IMRT,and 3DCRT plans had similar median Dmeanvalues for the internal mammary nodes,which were 2 740.2,2973.9,and 2951.4 cGy,respectively. The analyses of the three individual intercostal spaces showed that there was no difference in Dmeanfor the first intercostal space or the second intercostal space between the three plans;For the third intercostal space,however,I-IMRT had a significantly higher Dmeanthan 3DCRT and F-IMRT. The analyses of the three individual plans showed that for each plan,the Dmeanwas the highest in the third intercostal space,followed by the second intercostal space and the first intercostal space. Conclusions All the three plans fail to attain an adequate prescribed dose to cure subclinical disease,and there is no significant difference among the three plans. Therefore,it is risky to exclude the internal mammary nodes using any one of the three radiotherapy techniques for patients with clinical indications for internal mammary nodes radiation. In the combination therapy including chemotherapy,endocrine therapy,and targeted therapy,however,further follow-up is needed to determine whether the incidental irradiation dose to the internal mammary nodes could meet clinical requirement.

9.
Article in Chinese | WPRIM | ID: wpr-706298

ABSTRACT

Objective To explore the feasibility of MR lymphography (MR-LG) in detecting internal mammary sentinel lymph node (SLN) for rabbit models of VX2 breast cancer.Methods Totally 75 New Zealand white rabbits were randomly divided into 2 groups to establish VX2 breast cancer (tumor group) and inflammation models (inflammation group),respectively.MR-LG examinations and lymph node dissection were performed in all the rabbits.The results of internal mammary SLN and lymphatic vessels mapping were recorded,and the influence factors were analyzed.Results The success rate of model establishment was 97.33% (73/75).The detection rate of internal mammary SLN and lymphatic vessels was 15.94% (11/69) and 75.36% (52/69),respectively,there was no statistical difference between the two groups (both P>0.05).The rabbit's weight,time of tumor growth,tumor size,number,size and status of axillary SLN,as well as presence or not of internal mammary lymph vessels detection showed no statistical difference between detection and non-detection of internal mammary SLN (all P>0.05),while the tumor size and axillary lymph node number showed statistically significant differences between detection and not detection of internal lymphatic vessels (both P<0.05).The accuracy,sensitivity,specificity,false negative and false positive rate of internal mammary SLN detection with MR-LG was 76.81% (53/69),39.13%(9/23),95.65%(44/46),60.86%(14/23) and 4.35%(2/46),respectively.Conclusion MR-LG can effectively detect internal mammary SLN and lymphatic vessels for rabbit models of VX2 breast cancer.

10.
Article in Chinese | WPRIM | ID: wpr-613008

ABSTRACT

Internal mammary lymph node irradiation (IMLNI) could reduce local recurrence and distant recurrence and improve survival.The NCCN Guidelines have updated the recommends in IMLNI.However, the relative toxicities of IMLNI to the heart and lungs should be carefully considered by clinicians, so individualized indications for IMLNI are needed.Internal mammary sentinel lymph node biopsy (IM-SLNB) could be an accurate technique to guide IMLNI with minimally invasive staging, and provide more survival benefits to patients.This article reviews the benefits of IMLNI, controls of the side effect, and discussion of IMLNI guided by IM-SLNB.

11.
Article in Chinese | WPRIM | ID: wpr-663224

ABSTRACT

Internal mammary lymph nodes (IMLN) constitutes approximately 25% of the lymph nodes of the breast. The status of IMLN is one of the prognostic factors in breast cancer patients and essential to regional staging and adjuvant treatment choice. Inter-nal mammary-sentinel lymph node biopsy (IM-SLNB) is deemed a minimally invasive technique for the effective evaluation of IMLN sta-tus and useful in individualized diagnosis and treatment. Injecting radiotracer into glands around the areola through a modified injec-tion technique and at increased injection dose results in the high identification rate of internal mammary sentinel lymph node (IMSLN). Thus, routine IM-SLNB is feasible in clinical practice. Internal mammary lymph drainage pattern is extensively studied, and the accuracy of IM-SLNB guided by modified injection technique is gaining preliminary validation. This review summarizes the progress in diagnosis and treatment of IMLN of breast cancer.

12.
Cancer Research and Clinic ; (6): 793-795,806, 2011.
Article in Chinese | WPRIM | ID: wpr-589678

ABSTRACT

The metastases status of internal mammary lymph node(IMLN) is an independent prognostic factor for breast cancer and it also is an important reference for neoplasm staging.The patients with IMLN metastases consistently have worse outcomes.The overall risk of IMLN metastases is 18 %-33 %.Metastases exclusively situated in the IMLN,without concurrent axillary metastases,occur in 2 %-11% of patients.Factors related to IMLN metastases include the status of axillary node,the age of patients,the localization and characteristics of primary tumor.Recently,with the development of sentinel lymph node biopsy(SLNB), internal mammary-SLNB may access the status of IMLN with a minimal risk. Internal mammary-SLNB procedure can improve the system for nodal staging of breast cancer,and it will contribute to the individualized treatment for breast cancer patients.

13.
Article in Korean | WPRIM | ID: wpr-51892

ABSTRACT

PURPOSE: This study was designed to determine the optimum radiotherapy technique for internal mammary node (IMN) irradiation after breast-conserving surgery. MATERIALS AND METHODS: We selected ten cases of early stage partial mastectomy for plan comparison. Five of the patients were treated to the right-side breast and the rest of the patients were treated to the left-side breast. For each case, four different treatment plans were made to irradiate the entire breast, IMNs and supraclavicular lymph nodes (SCLs). The four planning techniques include a standard tangential field (STF), wide tangential field (WTF), partially wide tangential field (PWT) and a photon-electron mixed field (PEM). We prescribed a dose of 50.4 Gy to the SCL field at a 3 cm depth and isocenter of the breast field. RESULTS: The dose distribution showed clear characteristics depending on the technique used. All of the techniques covered the breast tissue well. IMN coverage was also good, except for the STF, which was not intended to cover IMNs. For the cases of the left-side breasts, the volume of the heart that received more than 30 Gy was larger (in order) for the WTF, PWT, PEM and STF. For radiation pneumonitis normal tissue complication probability (NTCP), the PWT showed the best results followed by the STF. CONCLUSION: Despite the variety of patient body shapes, the PWT technique showed the best results for coverage of IMNs and for reducing the lung and heart dose.


Subject(s)
Breast , Breast Neoplasms , Heart , Humans , Lung , Lymph Nodes , Mastectomy, Segmental , Planning Techniques , Radiation Pneumonitis
14.
Article in English | WPRIM | ID: wpr-159790

ABSTRACT

PURPOSE: To evaluate the association between radiation pneumonitis and dose-volume histogram parameters and to provide practical guidelines to prevent radiation pneumonitis following radiotherapy administered for breast cancer including internal mammary lymph nodes. MATERIALS AND METHODS: Twenty patients with early breast cancer who underwent a partial mastectomy were involved in this study. The entire breast, supraclavicular lymph nodes, and internal mammary lymph nodes were irradiated with a dose of 50.4 Gy in 28 fractions. Radiation pneumonitis was assessed by both radiological pulmonary change (RPC) and by evaluation of symptomatic radiation pneumonitis. Dose-volume histogram parameters were compared between patients with grade or =2 RPC. The parameters were the mean lung dose, V10 (percent lung volume receiving equal to and more than 10 Gy), V20, V30, V40, and normal tissue complication probability (NTCP). RESULTS: Of the 20 patients, 9 (45%) developed grade 2 RPC and 11 (55%) did not develop RPC (grade 0). Only one patient developed grade 1 symptomatic radiation pneumonitis. Univariate analysis showed that among the dose-volume histogram parameters, NTCP was significantly different between the two RPC grade groups (p<0.05). Fisher's exact test indicated that an NTCP value of 45% was appropriate as an RPC threshold level. CONCLUSION: This study shows that NTCP can be used as a predictor of RPC after radiotherapy of the internal mammary lymph nodes in breast cancer. Clinically, it indicates that an RPC is likely to develop when the NTCP is greater than 45%.


Subject(s)
Breast Neoplasms , Breast , Humans , Lung , Lymph Nodes , Mastectomy, Segmental , Radiation Pneumonitis , Radiotherapy
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