Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.
Int J Radiat Oncol Biol Phys. 2010 Jul 15;77(4):1113-9. doi: 10.1016/j.ijrobp.2009.06.081. Epub 2009 Dec 11.
To investigate the incidence and local control of internal mammary lymph node metastases (IMN+) in patients with clinical N2 or N3 locally advanced breast cancer.
We retrospectively reviewed the records of 809 breast cancer patients diagnosed with advanced nodal disease (clinical N2-3) who received radiation treatment at our institution from January 2000 December 2006. Patients were considered IMN+ on the basis of imaging studies.
We identified 112 of 809 patients who presented with IMN+ disease (13.8%) detected on ultrasound, computed tomography (CT), positron emission tomography/CT (PET/CT), and/or magnetic resonance imaging (MRI) studies. All 112 patients with IMN+ disease received anthracycline and taxane-based chemotherapy. Neoadjuvant chemotherapy (NCT) resulted in a complete response (CR) on imaging studies of IMN disease in 72.1% of patients. Excluding 16 patients with progressive disease, 96 patients received adjuvant radiation to the breast or the chest wall and the regional lymphatics including the IMN chain with a median dose of 60 Gy if the internal mammary lymph nodes normalized after chemotherapy and 66 Gy if they did not. The median follow-up of surviving patients was 41 months (8-118 months). For the 96 patients able to complete curative therapy, the actuarial 5-year IMN control rate, locoregional control, overall survival, and disease-free survival were 89%, 80%, 76%, and 56%.
Over ten percent of patients with advanced nodal disease will have IMN metastases on imaging studies. Multimodality therapy including IMN irradiation achieves excellent rates of control in the IMN region and a DFS of more than 50% after curative treatment.
研究临床 N2 或 N3 局部晚期乳腺癌患者内乳淋巴结转移（IMN+）的发生率和局部控制率。
我们回顾性分析了 2000 年 1 月至 2006 年 12 月在我院接受放射治疗的 809 例诊断为晚期淋巴结疾病（临床 N2-3）的乳腺癌患者的记录。根据影像学研究，患者被认为存在 IMN+。
我们发现 809 例患者中有 112 例（13.8%）在超声、计算机断层扫描（CT）、正电子发射断层扫描/CT（PET/CT）和/或磁共振成像（MRI）研究中检测到 IMN+疾病。所有 112 例 IMN+疾病患者均接受了蒽环类和紫杉类为基础的化疗。新辅助化疗（NCT）使 72.1%的患者的 IMN 疾病影像学检查达到完全缓解（CR）。排除 16 例进展性疾病患者，96 例患者接受了辅助乳房或胸壁以及包括内乳链的区域淋巴结放疗，化疗后如果内乳淋巴结正常则给予中位数剂量 60 Gy，如果未正常则给予 66 Gy。存活患者的中位随访时间为 41 个月（8-118 个月）。对于 96 例能够完成根治性治疗的患者，IMN 区域的 5 年累积 IMN 控制率、局部区域控制率、总生存率和无病生存率分别为 89%、80%、76%和 56%。
在影像学研究中，超过 10%的晚期淋巴结疾病患者将有 IMN 转移。包括 IMN 照射在内的多模态治疗可实现 IMN 区域的优异控制率，在根治性治疗后，DFS 超过 50%。
