Regional lymph node radiotherapy in breast cancer
single anterior supraclavicular field vs. two anterior and posterior opposed supraclavicular fields
Keywords:
Breast cancer; Supraclavicular; Axillary; Lymph node; Body Mass Index (BMI)Abstract
Background: The treatment of lymph nodes engaged in breast cancer with radiotherapy leads to improved locoregional control and enhanced survival rates in patients after surgery. The aim of this study was to compare two treatment techniques, namely single anterior posterior (AP) supraclavicular field with plan depth and two anterior and posterior opposed (AP/PA) supraclavicular fields. In the study, we also examined the relationships between the depth of supraclavicular lymph nodes (SCLNs) and the diameter of the wall of the chest and body mass index (BMI).
Methods: Forty patients with breast cancer were analyzed using computed tomography (CT) scans. In planning target volume (PTV), the SCLNs and axillary lymph nodes (AXLNs) were contoured, and, with the attention to PTV, supraclavicular (SC) depth was measured. The dosage that reached the aforementioned lymph nodes and the level of hot spots were investigated using two treatment methods, i.e., 1) AP/PA and 2) AP with three-dimensional (3D) planning. Each of these methods was analyzed using the program Isogray for the 6 MV compact accelerator, and the diameter of the wall of the chest was measured using the CT scan at the center of the SC field.
Results: Placing the plan such that 95% of the target volume with 95% or greater of the prescribed dose of 50 Gy (V95) had ≥95% concordance in both treatment techniques. According to the PTV, the depth of SCLNs and the diameter of the wall of the chest were 3-7 and 12-21cm, respectively. Regression analysis showed that the mean SC depth (the mean Plan depth) and the mean diameter of the wall of the chest were related directly to BMI (p<0.0001, adjusted R2=0.67) and (p<0.0001, adjusted R2=0.71), respectively.
Conclusion: The AP/PA treatment technique was a more suitable choice of treatment than the AP field, especially for overweight and obese breast cancer patients. However, in the AP/PA technique, the use of a single-photon, low energy (6 MV) caused more hot spots than usual.
References
Pierce, L.J., et al., 1998-1999 patterns of care study process survey of national practice patterns using breast- conserving surgery and radiotherapy in the management of stage I-II breast cancer. Int J Radiat Oncol Biol
Phys. 2005;62(1):183-92. Doi: 10.1016/j.ijrobp.2004.09.019, PMID:15850920
Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F. et al. Postoperative radiotherapy in
high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer
Cooperative Group 82b Trial. N Engl J Med. 1997; 337(14): 949-55. Doi: 10.1056/NEJM199710023371401.
PMID:9395428
Ragaz, J., et al., Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast
cancer. N Engl J Med. 1997;337(14): 956-62. Doi: 10.1056/NEJM199710023371402. PMID:9309100
Whelan TJ, Lada BM, Laukkanen E, Perera FE, Shelley WE, Levine MN. Breast irradiation in women with
early stage invasive breast cancer following breast conservation surgery. Provincial Breast Disease Site Group.
Cancer Prev Control. 1997; 1(3): 228-40. PMID: 9765748
Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML Does locoregional radiation therapy improve survival in
breast cancer? A meta-analysis. J Clin Oncol. 2000;18(6):1220-9. PMID: 10715291
White J, Moughan J, Pierce LJ, Morrow M, Owen J, Wilson JF. Status of postmastectomy radiotherapy in the
United States: a patterns of care study. Int J Radiat Oncol Biol Phys. 2004; 60(1): 77-85. Doi:
1016/j.ijrobp.2004.02.035. PMID: 15337542
Bentel GC, Marks LB, Hardenbergh PH, Prosnitz LR. Variability of the depth of supraclavicular and axillary
lymph nodes in patients with breast cancer: is a posterior axillary boost field necessary? Int J Radiat Oncol Biol
Phys, 2000; 47(3): 755-8. Doi: 10.1016/S0360-3016(00)00485-5. PMID: 10837961
Liengsawangwong R, Yu TK, Sun TL, Erasmus JJ, Perkins GH, Tereffe W. et al., Treatment optimization using
computed tomography-delineated targets should be used for supraclavicular irradiation for breast cancer. Int J
Radiat Oncol Biol Phys. 2007; 69(3): 711-5. Doi: 10.1016/j.ijrobp.2007.05.075, PMID: 17889264, PMCID:
Qatarneh SM, Kiricuta IC, Brahme A, Tiede U, Lind BK. Three-dimensional atlas of lymph node topography
based on the visible human data set. Anat Rec B New Anat. 2006; 289:98–111. PMID: 16783763
Madu CN, Quint DJ, Normolle DP, Marsh RB, Wang EY, Pierce LJ. Definition of the supraclavicular and
infraclavicular nodes: implications for three-dimensional CT-based conformal radiation therapy. Radiology. 2001; 221:333–339. PMID: 11687672
Goodman RL, Grann A, Saracco P, Needham MF. The relationship between radiation fields and regional lymph
nodes in carcinoma of the breast. IntJ Radiat Oncol Biol Phys. 2001;50(1): 99-105. Doi: 10.1016/S0360- 3016(00)01581-9. PMID: 11316551
Jephcott, C.R., S. Tyldesley, and C.L. Swift, Regional radiotherapy to axilla and supraclavicular fossa for
adjuvant breast treatment: a comparison of four techniques. Int J Radiat Oncol Biol Phys. 2004;60(1): 103-10.
Doi: 10.1016/j.ijrobp.2004.02.057. PMID: 15337545
Jabbari K1, Azarmahd N, Babazade S, Amouheidari A. Optimizing of the tangential technique and
supraclavicular fields in 3 dimensional conformal radiation therapy for breast cancer. J Med Signals Sens. 2013
Apr;3(2):107-16. PMID: 240988642, PMCID: PMC3788192.
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