Department of Radiation Oncology, Henri Mondor Breast Center, AP-HP, GH Henri Mondor, University of Paris-Est Créteil (UPEC), Créteil, France.
Ann Oncol. 2013 Aug;24(8):2023-8. doi: 10.1093/annonc/mdt151. Epub 2013 Apr 24.
Recent data from ACOSOG Z0011 and NSABP B32 trials suggested no need for axillary lymph node dissection (ALND) in patients with micrometastatic involvement of the sentinel lymph node (SLN). The low rate of axillary recurrence was attributed to the axilla coverage by the tangential fields (TgFs) irradiation and systemic therapy. This study aimed to evaluate dose distribution and coverage of the axilla levels I-II and the SLN area.
One hundred and nine patients were analyzed according to three groups: group 1 (50 Gy; n = 18), group 2 (60 Gy; n = 34) and group 3 (66 Gy; n = 57). Patients were treated using the standard (STgF; n = 22) or high (HTgF; n = 87) TgF.
The median doses delivered to level I using HTgF versus STgF were 33 and 20 Gy (P = 0.0001). The mean dose delivered to the SLN area was only 28 Gy. Additionally, the SLN area was totally included in the HTgF in 1 out of 12 patients who had intraoperative clip placement in the SNL area.
TgFs provide a limited coverage of the axilla and the SNLB area. This information should be considered when only TgFs are planned to target the axilla in patients with a positive SLN without ALND. Standardization of locoregional radiotherapy in this situation is urgently needed.
ACOSOG Z0011 和 NSABP B32 试验的最新数据表明，对于前哨淋巴结 (SLN) 有微转移受累的患者，无需进行腋窝淋巴结清扫术 (ALND)。腋窝复发率低归因于切线野 (TgF) 照射和全身治疗对腋窝的覆盖。本研究旨在评估腋窝 I-II 水平和 SLN 区域的剂量分布和覆盖情况。
根据三组进行了 109 名患者的分析：组 1（50Gy；n=18）、组 2（60Gy；n=34）和组 3（66Gy；n=57）。患者采用标准（STgF；n=22）或高（HTgF；n=87）TgF 治疗。
HTgF 与 STgF 相比，I 水平的中位剂量分别为 33Gy 和 20Gy（P=0.0001）。SLN 区域的平均剂量仅为 28Gy。此外，在 12 名术中在 SNL 区域放置夹的患者中，1 名患者的 HTgF 完全包含 SLN 区域。
TgF 仅对 SLN 阳性且无 ALND 的患者的腋窝提供有限的覆盖范围和 SLNBL 区域。在这种情况下，当仅计划使用 TgFs 靶向腋窝时，应考虑这种信息。迫切需要对这种情况下的局部区域放疗进行标准化。
