Clinical Research Papers:
Dose coverage of axillary level I-III areas during whole breast irradiation with simplified intensity modulated radiation therapy in early stage breast cancer patients
Metrics: PDF 892 views | HTML 1446 views | ?
Li Zhang1,*, Zhao-zhi Yang1,*, Xing-xing Chen1,*, Jeffrey Tuan3, Jin-li Ma1, Xin Mei1, Xiao-li Yu1, Zhi-rui Zhou1, Zhi-min Shao2, Guang-yu Liu2 and Xiao-mao Guo1
1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
2 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
3 Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
* These authors have contributed equally to this work
Guang-yu Liu, email:
Xiao-mao Guo, email:
Keywords: breast cancer; positive sentinel lymph nodes, radiotherapy, intensity modulated radiation therapy, axillary level
Received: March 27, 2015 Accepted: May 18, 2015 Published: May 27, 2015
Purpose: This study was designed to evaluate the dose coverage of axillary areas during whole breast irradiation with simplified intensity modulated radiation therapy (s-IMRT) and field-in-field IMRT (for-IMRT) in early stage breast cancer patients.
Methods: Sixty-one consecutive patients with breast-conserving surgery and sentinel lymph node biopsy were collected. Two plans were created for each patient: the s-IMRT and for-IMRT plan. Dosimetric parameters of axillary areas were compared.
Results: The average of mean doses delivered to the axillary level I areas in s-IMRT and for-IMRT plan were 27.7Gy and 29.1Gy (p = 0.011), respectively. The average of V47.5Gy, V45Gy and V40Gy (percent volume receiving≥ 47.5Gy, 45Gy and 40Gy) of the axillary level I in s-IMRT plan was significantly lower than that in for-IMRT plan (p < 0.001). For for-IMRT plans, patients with upper tangential border to humeral head ≤2cm, breast separation >19.3cm and body width >31.9cm had significantly higher mean dose in axillary level I area (p = 0.002, 0.007, 0.001, respectively).
Conclusion: Compared with for-IMRT plan, the s-IMRT plan delivered lower dose to axillary level I area. For centers using s-IMRT technique, caution should be exercised when selecting to omit axillary lymph node dissection for patients with breast conserving surgery and limited positive SLNs.
All site content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License.