Clinical outcomes after sentinel lymph node biopsy in clinically node-negative breast cancer patients

PURPOSE: To evaluate non-sentinel lymph node (LN) status after sentinel lymph node biopsy (SNB) in patients with breast cancer and to identify the predictive factors for disease failure. MATERIALS AND METHODS: From January 2006 to December 2007, axillary lymph node (ALN) dissection after SNB was performed for patients with primary invasive breast cancer who had no clinical evidence of LN metastasis. A total of 320 patients were treated with breast-conserving surgery and radiotherapy. RESULTS: The median age of patients was 48 years, and the median follow-up time was 72.8 months. Close resection margin (RM) was observed in 13 patients. The median number of dissected SNB was two, and that of total retrieved ALNs was 11. Sentinel node accuracy was 94.7%, and the overall false negative rate (FNR) was 5.3%. Eleven patients experienced treatment failure. Local recurrence, regional LN recurrence, and distant metastasis were identified in 0.9%, 1.9%, and 2.8% of these patients, respectively. Sentinel LN status were not associated with locoregional recurrence (p > 0.05). Close RM was the only significant factor for disease-free survival (DFS) in univariate and multivariate analysis. The 5-year overall survival, DFS, and locoregional DFS were 100%, 96.8%, and 98.1%, respectively. CONCLUSION: In this study, SNB was performed with high accuracy and low FNR and high locoregional control was achieved.

The Irradiated Lung Volume in Tangential Fields for the Treatment of a Breast / 대한치료방사선과학회지

PURPOSE: Radiation pneumonitis is one of the complications caused by radiation therapy that includes a portion of the lung tissue. The severity of radiation induced pulmonary dysfunction depends on the irradiated lung volume, total dose, dose rate and underlying pulmonary function. It also depends on whether chemotherapy is done or not. The irradiated lung volume is the most important factor to predict the pulmonary dysfunction in breast cancer patients following radiation therapy. There are some data that show the irradiated lung volume measured from CT scans as a part of treatment planning with the tangential beams. But such data have not been reported in Korea. We planned to evaluate the irradiated lung volume quantitatively using CT scans for the breast tangential field and search for useful factors that could predict the irradiated lung volume. MATERIALS AND METHODS: The lung volume was measured for 25 patients with breast cancer irradiated with tangential field from Jan.1995 to Aug.1996. Parameters that can predict the irradiated lung volume included; (1) the perpendicular distance from the posterior tangential edge to the posterior part of the anterior chest wall at the center of the field (CLD); (2) the maximum perpendicular distance from the posterior tangential field edge to the posterior part of the anterior chest wall (MLD); (3) the greatest perpendicular distance from the posterior tangential edge to the posterior part of anterior chest wall on CT image at the center of the longitudinal field (GPD); (4) the length of the longitudinal field (L). The irradiated lung volume(RV), the entire both lung volume(EV) and the ipsilateral lung volume(IV) were measured using dose volume histogram. The relationship between the irradiated lung volume and predictors was evaluated by regression analysis. RESULTS: The RV is 61-279cc (mean 170cc), the RV/EV is 2.9-13.0% (mean 5.8%) and the RV/IV is 4.9-29.6% (mean 12.2%). The CLD, the MLD and the GPD are 1.9-3.3cm, 1.9-3.3cm and 1.4-3.1cm respectively. The significant relations between the irradiated lung volume such as RV, RV/EV, RV/IV and parameters such as CLD, MLD, GPD, L, CLDxL, MLDxL and GPDxL are not found with little variances in parameters. The RV/IV of the left breast irradiation is significantly larger than that of the right but the RV/EVs do not show the differences. There is no symptomatic radiation pneumonitis at least during 6 months follow up. CONCLUSION: The significant relationship between the irradiated lung volume and predictors is not found with little variation on parameters. The irradiated lung volume in the tangential field is less than 10% of entire lung volume when CLD is less than 3cm. The RV/IV of the left tangential field is larger than that of the right but there was no significant differences in RV/EVs. Symptomatic radiation pneumonitis has not occurred during minimum 6 months follow up.

Therapeutic Results of Radiation Therapy Alone and Combination with Chemotherapy in Non-Small Cell Lung Carcinoma / 대한치료방사선과학회지

Between November 1983 and December 1992, 121 patients with non-small cell lung cancer were treated with radiotherapy alone or combined with chemotherapy in Inje University, Seoul Paik Hospital. Of these, 97 patients were evaluable and analyzed retrospectively. Group 1(n=62) was treated with radiotherapy alone and group 2(n=35) combined with chemotherapy. There were 7 patients, 1 patient with stage I and II, 20 patients, 11 patients with stage IIIA, 28 patients,20 patients with stage IIIB, and 6 patients, 3 patients with stage IV, respectively. Ninety percent of patients received more than 5000 cGy of radiaton. Median survival of patients in group 1 was 9 months, group 2 was 15 months. Overall 2 year survival rates of group 1 and 2 were 37% and 27%, respectively. Relapse free survival rates at 2 year were 27% and 15%, respectively. Overall survival rates at 5 year for group 1 and 2 were 15% and 11%, and relapse free survival rates were 16% and 6%, respectively. Median survival of complete and partial responders was 17 months in group 1, 18 Months in group 2, and those of stable or progression was 6 mouths, 11 months, respectively. The proportion of locoregional relapse and distant metastasis was not significantly different between group 1 and 2. The majority of relapse developed within 2 years. Although 2 cases of severe esophagitis and myelosuppression were noted in group 2, the treatment related toxicity was relatively acceptable. Our analysis showed no statistically significant differences between the two treatment groups in terms of response rate, survival, and sites of relapse.

Results of Postoperative Radiotherapy for Breast Carcinoma / 대한치료방사선과학회지

Between December 1983 and December 1989, twenty-five breast carcinoma patients were treated with surgical resection and postoperative radiotherapy at Inje University Seoul Paik Hospital. Twenty-three of 25 were evaluable and there were 7 patients with stageII, 14 patients with stageIII, and 2 patients with stageIV. Twenty-one patients were treated with modified radical mastectomy and the remained 2 patients with simple mastectomy. The follow-up period ranged from 2 to 8 years. The local control rate was 83c13 for the entire group. The local control rates for each stage were 100%(6/6) for stage II, 73%(l1/15) for stageIII, and 100%(2/2) for stageIV. The number of metastatic axillary nodes was a good predictor of locoregional cotrol. It was 100% for the patients with 0-3 metastatic nodes and 72% for more than 4 nodes, respectively. The 5-year overall survival rate for the entire group was 59%, and the disease-free survival rate was 32%. The 5-year survival rates for each stageII,III and IV was 83%, 59% and 50%, respectively. The distant metastasis occurred in 10 out of 23 patients and the most common site was bone. The results indicate that postoperative radiotherapy continues to play an important role in the primary mangement of the high-risk breast cancer patients.

Concurrent Week1y Cisplatin and Radiation Therapy for High risk group of Uterine Cervical Cancer / 대한치료방사선과학회지

Locally advanced cervical carcinoma has shown high rate of local failure and poor survival rate despite the advances in modern radiation therapy techniques. Combination of chemotherapy and radiation therapy demonstrated benefit in improving local control and possibly the overall survival. Twelve patients with advanced stages(Figo stage III, IV) or 11b with bulky tumors(>5 cm in diameter) were treated with combination of radiation therapy and concurrent weekly cisplatin between May of 1988 and September of 1991 at Inje University Paik Hospital. Cisplatin was administered in bolus injections of 50mg at weekly intervals during the courses of radiation therapy. Median follow-up period was 34 months with ranges from 3 to 53 months. Eleven patients were evaluable for the estimation of response. Response was noted in all the 11 patients: complete response(CR) in 7(64%), partial response (PR) in 4(36%). Of the 7 patients with CR, all maintained local control, whereas only 1 of 4 with PR showed local control. Six of 7 with CR are alive disease free on the completion of follow-up. Eight of 11 patients (73%) maintained local control in the pelvis. The Median survival for CR patient is 27 months and 9 months for the PR patients. Analysis of survival by stage shows 11 b 4/5, III 2/3 and IV 1/3. Overall survival rate was 61%. Three patients recurred : 1 at local, 1 in distant site and 1 with local and distant site. Toxicity for the combination therapy was not excessive. These results are preliminary, but definitely encouraging in view of markedly improved response rate compared with the results of historical control group.

Radiotherapeutic Result of waldeyer's Ring Lymphoma / 대한치료방사선과학회지

Twenty patients with biopsy-proven Waldeyer's ring lymphoma were treated with radiotherapy between 1984 and 1990 at the Department of Radiation Therapy, Inje University Paik Hospital and seventeen evaluable patients were analysed retrospectively. Dose of radiation ranged from 35 to 50 gy to Waldeyer's ring structure with an additional 5 and 10 gy boost dose to the primary site. The lower cervical nodes received 35 to 60 gy. The median follow-up period was 24 months (range; 9 to 80 months). The 5-year overall survival rate was 50.2% and 5-year disease free survival rate was 47.1%. The final local control rate was 82.4%. The relapse developed average 10 months after treatment. Most of relapses were systemic (87.5%). The patients with stage I disease fared better than advance stage. The favorable histology of lymphoma showed better prognosis than unfavorable histology. There was no significant difference in survival rate between radiotherapy alone and combination of chemotherapy and radiotherapy in early stage lymphomas. But of the patients with advanced stage, those who received chemotherapy and radiotherapy had better prognosis than those treated with radiotherapy alone.