Aristei C, Chionne F, Marsella A R, Alessandro M, Rulli A, Lemmi A, Perrucci E, Latini P
Institute of Radiotherapy Oncology, General Hospital and Perugia University, Perugia, Italy.
Int J Radiat Oncol Biol Phys. 2001 Sep 1;51(1):69-73. doi: 10.1016/s0360-3016(01)01595-4.
To evaluate if Level I and II axillary nodes are included in the standard breast tangential fields, and to calculate the dose administered.
In 35 patients treated with conservative surgery and axillary dissection, three clips were surgically positioned: one at the beginning of Level I, one between Level I and II, and another at the end of Level II. The breast was irradiated with two tangential fields. On simulation films, the volume between the clips was scored as "entirely included" or "not entirely included" in the treatment fields. Computed tomography (CT) scans were performed; CT data were imported into a treatment planning system, and three-dimensional plans were devised. Axillary Levels I and II were delineated on CT slices on the basis of anatomic landmarks. Fields and isodose curves previously obtained were superimposed to calculate the dose administered to the first two axillary node levels and to 90% of both volumes.
On X-rays, the volume between clips corresponding to Level I was completely included in the medial field in 66.7% of cases and in the lateral field in 63.7% of cases, whereas the volume of Level II was entirely included in the medial field in 54.5% of cases and in the lateral field in 45.4% of cases. The median dose administered to Level I and II was 38.58 Gy +/- 11.01 (range 3.46-47.14) and 20.65 Gy +/- 14.07 (range 0.95-38.94), respectively. The median dose to 90% of both volumes of Level I and II was 6.75 Gy +/- 14.01 (range 1.9-39) and 1.75 Gy +/- 9.72 (range 0.8-29), respectively.
The standard tangential fields do not entirely include Levels I and II axillary nodes.
评估标准乳腺切线野是否包括Ⅰ级和Ⅱ级腋窝淋巴结，并计算所给予的剂量。
对35例行保乳手术及腋窝清扫术的患者，术中放置3个夹子：一个位于Ⅰ级起点，一个位于Ⅰ级和Ⅱ级之间，另一个位于Ⅱ级终点。用两个切线野对乳腺进行照射。在模拟片上，夹子之间的体积被标记为在治疗野中“完全包括”或“未完全包括”。进行计算机断层扫描（CT）；将CT数据导入治疗计划系统，并设计三维计划。根据解剖标志在CT切片上勾画出Ⅰ级和Ⅱ级腋窝。将先前获得的野和剂量曲线叠加，以计算给予前两个腋窝淋巴结水平以及两个体积的90%的剂量。
在X射线上，对应Ⅰ级的夹子之间的体积在66.7%的病例中完全包括在内侧野，在63.7%的病例中包括在外侧野；而Ⅱ级的体积在54.5%的病例中完全包括在内侧野，在45.4%的病例中包括在外侧野。给予Ⅰ级和Ⅱ级的中位剂量分别为38.58 Gy±11.01（范围3.46 - 47.14）和20.65 Gy±14.07（范围0.95 - 38.94）。Ⅰ级和Ⅱ级两个体积的90%的中位剂量分别为6.75 Gy±14.01（范围1.9 - 39）和1.75 Gy±9.72（范围0.8 - 29）。
标准切线野未完全包括Ⅰ级和Ⅱ级腋窝淋巴结。
