open access

Vol 20, No 1 (2015)
Original research articles
Published online: 2015-01-01
Submitted: 2014-01-03
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Comparison of two treatment strategies for irradiation of regional lymph nodes in patients with breast cancer: Lymph flow guided portals versus standard radiation fields

Sergey Nikolaevich Novikov, Sergey Vasilevich Kanaev, Vladimir Fedorovich Semiglazov, Ludmila Alekseevna Jukova, Pavel Ivanovich Krzhivitckiy
DOI: 10.1016/j.rpor.2014.06.001
·
Rep Pract Oncol Radiother 2015;20(1):27-31.

open access

Vol 20, No 1 (2015)
Original research articles
Published online: 2015-01-01
Submitted: 2014-01-03

Abstract

Aim and Background

Radiotherapy being an essential part of breast cancer treatment, we evaluate various radiotherapy strategies in patients with breast cancer.

Materials and methods

Lymph node (LN) scintigraphy was performed in 172 primary patients with BC. LN visualization started 30–360[[ce:hsp sp="0.25"/]]min after intratumoral injection of 75–150 MBq of 99mTc-nanocolloids.

Our standard recommendation for postoperative radiotherapy in patients with LN invasion by BC were as follows: for patients with external localization of tumour – breast[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]axillary (Ax)[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]sub-supraclavicular (SSCL) regions; with internal localization – all above[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]internal mammary nodes (IM). Proposed strategy of lymph flow guided radiotherapy is based on the assumption that only regions that contain ‘hot’ LNs must be included in a treatment volume.

Results

Among 110 patients with external localization of BC, Ax LNs were visualized in all cases and in 62 patients it was the only region with ‘hot’ LN. Twenty-three patients (20.9%) had drainage to Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]SSCL, 12 (10.9%) – Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]IM, 13 (11.8%) – Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]SSCL[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]IM regions. After the visualization of lymph flow patterns, standard treatment volume was changed in 87/110 cases (79.1%): in 56.4%, reduced, in 22.7%, enlarged or changed.

In 62 patients with tumours in internal quadrants, we revealed the following patterns of lymph-flow: only to the Ax region in 23 (37.1%); Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]IM, 13 (21%); Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]SSCL, 15 (24.2%); Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]IM[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]ISSCL, 11 (17.7%) cases. After lymph-flow visualization, the standard irradiation volume was reduced in 53/62 (85.5%) cases.

Conclusion

Visualization of an individual lymph flow pattern from BC can be used for the optimization of standard fields used for irradiation of regional LNs.

Abstract

Aim and Background

Radiotherapy being an essential part of breast cancer treatment, we evaluate various radiotherapy strategies in patients with breast cancer.

Materials and methods

Lymph node (LN) scintigraphy was performed in 172 primary patients with BC. LN visualization started 30–360[[ce:hsp sp="0.25"/]]min after intratumoral injection of 75–150 MBq of 99mTc-nanocolloids.

Our standard recommendation for postoperative radiotherapy in patients with LN invasion by BC were as follows: for patients with external localization of tumour – breast[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]axillary (Ax)[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]sub-supraclavicular (SSCL) regions; with internal localization – all above[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]internal mammary nodes (IM). Proposed strategy of lymph flow guided radiotherapy is based on the assumption that only regions that contain ‘hot’ LNs must be included in a treatment volume.

Results

Among 110 patients with external localization of BC, Ax LNs were visualized in all cases and in 62 patients it was the only region with ‘hot’ LN. Twenty-three patients (20.9%) had drainage to Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]SSCL, 12 (10.9%) – Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]IM, 13 (11.8%) – Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]SSCL[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]IM regions. After the visualization of lymph flow patterns, standard treatment volume was changed in 87/110 cases (79.1%): in 56.4%, reduced, in 22.7%, enlarged or changed.

In 62 patients with tumours in internal quadrants, we revealed the following patterns of lymph-flow: only to the Ax region in 23 (37.1%); Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]IM, 13 (21%); Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]SSCL, 15 (24.2%); Ax[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]IM[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]ISSCL, 11 (17.7%) cases. After lymph-flow visualization, the standard irradiation volume was reduced in 53/62 (85.5%) cases.

Conclusion

Visualization of an individual lymph flow pattern from BC can be used for the optimization of standard fields used for irradiation of regional LNs.

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Keywords

Breast cancer; Radiotherapy; Sentinel lymph-nodes

About this article
Title

Comparison of two treatment strategies for irradiation of regional lymph nodes in patients with breast cancer: Lymph flow guided portals versus standard radiation fields

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 20, No 1 (2015)

Pages

27-31

Published online

2015-01-01

DOI

10.1016/j.rpor.2014.06.001

Bibliographic record

Rep Pract Oncol Radiother 2015;20(1):27-31.

Keywords

Breast cancer
Radiotherapy
Sentinel lymph-nodes

Authors

Sergey Nikolaevich Novikov
Sergey Vasilevich Kanaev
Vladimir Fedorovich Semiglazov
Ludmila Alekseevna Jukova
Pavel Ivanovich Krzhivitckiy

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