Department of Radiation Oncology, The Morgan Welch Inflammatory Breast Cancer Clinic, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):1381-6. doi: 10.1016/j.ijrobp.2011.10.040. Epub 2012 Jan 26.
Positron emission tomography/computed tomography (PET/CT) is increasingly being utilized for staging of inflammatory breast cancer (IBC). The purpose of this study was to define how pretreatment PET/CT studies affected postmastectomy radiation treatment (PMRT) planning decisions for IBC.
We performed a retrospective analysis of 62 patients diagnosed with IBC between 2004 and 2009, who were treated with PMRT in our institution and who had a staging PET/CT within 3 months of diagnosis. Patients received a baseline physical examination, staging mammography, ultrasonographic examination of breast and draining lymphatics, and chest radiography; most patients also had a bone scan (55 patients), liver imaging (52 patients), breast MRI (46 patients), and chest CT (25 patients). We compared how PET/CT findings affected PMRT, assuming that standard PMRT would target the chest wall, level III axilla, supraclavicular fossa, and internal mammary chain (IMC). Any modification of target volumes, field borders, or dose prescriptions was considered a change.
PET/CT detected new areas of disease in 27 of the 62 patients (44%). The areas of additional disease included the breast (1 patient), ipsilateral axilla (1 patient), ipsilateral supraclavicular (4 patients), ipsilateral infraclavicular (1 patient), ipsilateral IMC (5 patients), ipsilateral subpectoral (3 patients), mediastinal (8 patients), other distant/contralateral lymph nodes (15 patients), or bone (6 patients). One patient was found to have a non-breast second primary tumor. The findings of the PET/CT led to changes in PMRT in 11 of 62 patients (17.7%). These changes included additional fields in 5 patients, adjustment of fields in 2 patients, and higher doses to the supraclavicular fossa (2 patients) and IMC (5 patients).
For patients with newly diagnosed IBC, pretreatment PET/CT provides important information concerning involvement of locoregional lymph nodes, mediastinal lymph nodes, and unsuspected sites of distant metastasis. This information is important in the design of radiotherapy treatment fields and, therefore, we recommend that PET/CT be a component of initial staging for IBC.
正电子发射断层扫描/计算机断层扫描（PET/CT）越来越多地用于炎性乳腺癌（IBC）的分期。本研究的目的是确定术前 PET/CT 研究如何影响 IBC 的乳房切除术放射治疗（PMRT）计划决策。
我们对 2004 年至 2009 年间在我们机构接受 PMRT 治疗且在诊断后 3 个月内进行分期 PET/CT 的 62 例 IBC 患者进行了回顾性分析。患者接受了基线体格检查、分期乳房 X 线摄影、乳房和引流淋巴结的超声检查以及胸部 X 线摄影；大多数患者还接受了骨扫描（55 例）、肝脏成像（52 例）、乳房 MRI（46 例）和胸部 CT（25 例）。我们比较了 PET/CT 结果如何影响 PMRT，假设标准 PMRT 将针对胸壁、III 级腋窝、锁骨上窝和内乳链（IMC）。任何靶区、野边界或剂量处方的修改均被视为改变。
在 62 例患者中有 27 例（44%）PET/CT 检测到新的疾病部位。额外疾病部位包括乳房（1 例）、同侧腋窝（1 例）、同侧锁骨上（4 例）、同侧锁骨下（1 例）、同侧 IMC（5 例）、同侧胸肌下（3 例）、纵隔（8 例）、其他远处/对侧淋巴结（15 例）或骨（6 例）。1 例患者被发现患有非乳房第二原发肿瘤。PET/CT 的结果导致 62 例患者中的 11 例（17.7%）PMRT 发生变化。这些变化包括 5 例患者增加了野，2 例患者调整了野，2 例患者锁骨上窝（2 例）和 IMC（5 例）增加了剂量。
对于新诊断的 IBC 患者，术前 PET/CT 提供了有关局部区域淋巴结、纵隔淋巴结和未被怀疑的远处转移部位受累的重要信息。这些信息对于放射治疗野的设计很重要，因此我们建议 PET/CT 成为 IBC 初始分期的一部分。
