RESUMEN
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.
RESUMEN
La glándula mamaria es una parte importante de la morfología femenina y su desarrollo constituye una de las características más destacadas de la diferenciación sexual. Cada día aumenta el número de pacientes sometidas a mastectomía por un diagnóstico cada vez más temprano de cáncer de mama y aunque el porcentaje es bajo, ahora son más las pacientes que deciden optar por el procedimiento, incrementándose nuestra experiencia en la técnica practicada en el Servicio de Cirugía Plástica y Unidad Nacional de Quemados del Hospital San Juan de Dios, con un agresivo programa de reconstrucción mamaria, específicamente con el colgajo músculo-cutáneo de Latísimo Dorsal, dorsal ancho, y prótesis de silicón. Hubo 78 pacientes que se sometieron a reconstrucción mamaria con la técnica de colgajo músculo-cutáneo de dorsal ancho, más prótesis de silicón. Estos casos fueron aportados por los médicos del servicio, las pacientes mismas y posteriormente, en su gran mayoría por la CCSS, la cual asumió el programa en su totalidad. Todas las prótesis fueron rellenas con silicón cohesivo o altamente cohesivo y de perfil alto o muy alto. Se reconstruyeron 78 mamas entre enero de 1999 y julio del 2003, por la técnica acá descrita en igual número de pacientes, quienes habían sido sometidas a mastectomía a causa de cáncer del seno...
The female breast is an important part of the woman and its development is one of the most remarkable characteristics on the sex differential. Every day more patients are mastectomized due to a good and early diagnosis of breast cancer. Eventhough the percentage is low, there are more patients looking for a breast reconstruction. This situation increment the experience of the plastic surgery department and the national burn unit of the Hospital San Juan de Dios, with a very aggressive program of breast reconstruction,specifically, using the technic of the Latissimus Dorsi Moycutaneos Flap and Silastic Gell Filled rosthesis. A total of 78 patients underwent breast reconstruction with the Latissimus Dorsi Flap and Silastic Gel Filled Prosthesis. The staff physician performed all of these and all the patients are from the Caja Costarricense de Seguro Social (CCSS). All of the 78 patients underwent breast reconstruction with the method described here between january of 1999 and july 2003. The medium age was 48.55 years. The surgical time was about 2 hours with 30 minutes in the patients were discharged in the first 24 hours in the 95% of the cases. The mastectomy affected the couple relationship; more than 50% of the woman lost her partner. No evidence of cancer recurrence was found on the chest wall. Patients and physicians are very satisfied with the reconstruction technic. The results and our experience are increasing every year. In our country breast cancer is early diagnosed, treated and reconstruction is following mastectomy. The prime interest of plastic surgeons is to developed a good program for reconstruction eventhough only 10% resort to this operation. We are sure that in the near future more patients will undergo this procedure (breast reconstruction) due to our excellent results, and for the anatomical and personal satisfaction obtained y the patient.