Schmitt M, Pin Y, Pflumio C, Mathelin C, Pivot X, Noël G
Radiotherapy department, institut de cancérologie Strasbourg Europe, 17, rue Albert-Calmette, 67200 Strasbourg, France.
Oncology department, institut de cancérologie Strasbourg Europe, 17, rue Albert-Calmette, 67200 Strasbourg, France.
Cancer Radiother. 2021 Apr;25(2):191-199. doi: 10.1016/j.canrad.2020.06.035. Epub 2021 Jan 2.
In breast cancer, radiotherapy is an essential component of the treatment. However, indications of irradiation of the internal mammary chain and axillary area are debatables. Axillary recurrence in patients with invasive breast carcinoma remains an issue. Currently, the substitution of axillary lymph node dissection by sentinel node biopsy leads to revisit the role of axillary irradiation. Breast irradiation including level I, II and III might decrease the risk of axillary recurrence.
A literature search was performed in PubMed and the Cochrane library to identify articles publishing data regarding dose-volume analysis of axillary levels in breast irradiation aiming to determine the potential therapeutic implications.
Eleven articles were retained. A total of 375 treatment plans were analyzed. The results concerning the irradiation technique, initial dose prescribed to breast, delineated volumes and dose received at axillary levels were heterogeneous. The average dose delivered to axilla levels I-III with 3D-conformal radiotherapy using standard fields were between 24Gy and 43.5Gy, 3Gy and 32.5Gy and between 1.0Gy and 20.5Gy respectively. The average doses delivered to axilla levels I-III with 3D-conformal radiotherapy using high tangential fields were between 38Gy and 49.7Gy, 11Gy and 47.1Gy and 5Gy 38.7Gy, 32.1Gy and 5Gy (result available for only one study) respectively. Finally, the average doses delivered to axilla levels I-III with intensity modulated radiation therapy were between 14.5Gy and 42.6Gy, 3.4Gy and 35Gy and between 1.2Gy and 25.5Gy respectively.
Incidental axillary dose seems insufficient to be therapeutic regardless of the irradiation technique. There are meaningful differences between intensity modulated radiation therapy and 3D-conformal radiotherapy.
在乳腺癌治疗中，放射治疗是重要组成部分。然而，内乳链和腋窝区域的照射指征存在争议。浸润性乳腺癌患者的腋窝复发仍是一个问题。目前，前哨淋巴结活检替代腋窝淋巴结清扫促使人们重新审视腋窝放疗的作用。包括Ⅰ、Ⅱ和Ⅲ级的乳腺照射可能会降低腋窝复发风险。
在PubMed和Cochrane图书馆进行文献检索，以确定发表有关乳腺照射腋窝各水平剂量体积分析数据的文章，旨在确定潜在的治疗意义。
保留11篇文章。共分析375个治疗计划。关于照射技术、乳腺初始处方剂量、勾画体积以及腋窝各水平接受的剂量的结果存在异质性。使用标准野的三维适形放疗给予腋窝Ⅰ - Ⅲ级的平均剂量分别在24Gy至43.5Gy、3Gy至32.5Gy以及1.0Gy至20.5Gy之间。使用高切线野的三维适形放疗给予腋窝Ⅰ - Ⅲ级的平均剂量分别在38Gy至49.7Gy、11Gy至47.1Gy以及5Gy至38.7Gy、32.1Gy至5Gy（仅一项研究有此结果）之间。最后，调强放射治疗给予腋窝Ⅰ - Ⅲ级的平均剂量分别在14.5Gy至42.6Gy、3.4Gy至35Gy以及1.2Gy至25.5Gy之间。
无论照射技术如何，偶然的腋窝剂量似乎不足以起到治疗作用。调强放射治疗和三维适形放疗之间存在显著差异。
