Jacobson Geraldine, Bunda-Randall Nicole, Wen Sijin, Miller Matthew
Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia.
School of Public Health, West Virginia University, Morgantown, West Virginia.
Adv Radiat Oncol. 2017 Jul 17;2(4):630-635. doi: 10.1016/j.adro.2017.07.005. eCollection 2017 Oct-Dec.
The American College of Surgeons Oncology Group Z0011 trial indicated no benefit from axillary lymph node (LN) dissection after a positive sentinel LN biopsy in patients receiving breast irradiation, suggesting that level I-II LNs were covered in tangential fields.
We evaluated 50 computed tomography-based tangential breast plans and contoured level I-III axillary LNs using the Radiation Therapy Oncology Group guidelines. The volumes of level I-III LN regions covered by 90% and 95% of the prescription dose (PD) were calculated and correlated with the V20 ipsilateral lung and mean heart dose. We calculated field length, distance from the humeral head, and separation. The Pearson correlation method and linear models were used in the correlative study.
Level I LN mean and median volume (MMV) covered by 90% of the PD were 46.8% and 47.2%, respectively. MMV covered by 95% of the PD was 30.8% and 29.62%. Mean and median dose to level I LNs were 29.03 Gy and 30.13 Gy, respectively. The MMV of level II LNs covered by 90% of the PD was 2.49% and 0%. The mean and median dose to level II LNs were 6.09 Gy and 2.12 Gy, respectively. The MMV of level III LNs was 0% with a mean and median dose of 1.04 Gy and 0.92 Gy, respectively. There was a moderate correlation between the 95% prescription coverage of level I LNs and V20 ipsilateral lung and a smaller correlation between 95% prescription coverage of level I LNs and mean heart dose. Distance from the humeral head was inversely correlated with coverage of level I and II LNs and positively correlated with V20 lung.
In most patients, <50% of the level I LN volume was covered by 90% of the PD and <30% was covered by 95%; <5% of the level II nodes were covered by 90% of the PD; and coverage was 0% for level III LNs.
美国外科医师学会肿瘤学组Z0011试验表明，在接受乳腺放疗的患者中，前哨淋巴结活检阳性后进行腋窝淋巴结清扫并无益处，这表明I-II级淋巴结在切线野范围内。
我们使用放射治疗肿瘤学组指南评估了50个基于计算机断层扫描的乳腺切线计划，并勾勒出I-III级腋窝淋巴结。计算了处方剂量（PD）的90%和95%所覆盖的I-III级淋巴结区域的体积，并将其与同侧肺V20和平均心脏剂量相关联。我们计算了野长、距肱骨头的距离和间距。在相关性研究中使用了Pearson相关方法和线性模型。
PD的90%所覆盖的I级淋巴结平均体积和中位数体积（MMV）分别为46.8%和47.2%。PD的95%所覆盖的MMV为30.8%和29.62%。I级淋巴结的平均剂量和中位数剂量分别为29.03 Gy和30.13 Gy。PD的90%所覆盖的II级淋巴结的MMV为2.49%和0%。II级淋巴结的平均剂量和中位数剂量分别为6.09 Gy和2.12 Gy。III级淋巴结的MMV为0%，平均剂量和中位数剂量分别为1.04 Gy和0.92 Gy。I级淋巴结的95%处方覆盖范围与同侧肺V20之间存在中度相关性，I级淋巴结的95%处方覆盖范围与平均心脏剂量之间的相关性较小。距肱骨头的距离与I级和II级淋巴结的覆盖范围呈负相关，与肺V20呈正相关。
在大多数患者中，PD的90%覆盖的I级淋巴结体积<50%，95%覆盖的<30%；PD的90%覆盖的II级淋巴结<5%；III级淋巴结的覆盖范围为0%。
