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Breast Cancer Research and Treatment

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01-07-2020 | Mastectomy | Clinical trial

Utilization patterns and temporal trends of internal mammary nodal irradiation at a tertiary cancer center

Authors: Shagun Misra, Grace Lee, Manjula Maganti, C. Anne Koch

Published in: Breast Cancer Research and Treatment | Issue 2/2020

Abstract

Purpose

The role and uptake of internal mammary nodal irradiation (IMNI) is variable. This study was designed to quantify the rates and determinants of IMNI at a tertiary cancer center.

Methods

Consecutively treated breast cancer patients receiving adjuvant locoregional radiation therapy (RT) from January 1, 2012 to December 31, 2017 were sorted by IMNI receipt, disease risk and time period of RT delivery (2012–2015 vs 2016–2017). Differences between risk categories and groups were evaluated using χ²/Fisher's and Mann–Whitney test for categorical and continuous variables, respectively. Univariable and multivariable logistic regression analysis was done to determine factors associated with IMNI receipt.

Results

A total of 1566 patients were eligible, with 376 in Group 1 (IMNI), and 1190 in Group 2 (no IMNI). The proportion of patients receiving IMNI increased significantly each year (p < 0.0001), and 83% of patients receiving IMNI had pT1-2/pN1 disease. On univariable analysis, younger age, lymphovascular invasion, medial/central quadrant, higher stage, PR negative, mastectomy, axillary dissection, receipt of chemotherapy and nodal positivity had higher odds of IMNI. On multivariable analysis, younger age (p = < 0.001), medial/central quadrant (p = 0.0026), PR negative (p = 0.0011), mastectomy (p = 0.0055), increasing nodal positivity (p < 0.0001) and late cohort (p = 0.001) had increased likelihood of IMNI. The use of deep-inspiration breath hold was significantly higher in those receiving IMNI (45% vs 26%, p < 0.0001), and permitted achievement of acceptable mean heart and lung doses.

Conclusions

There was a significant increase in IMNI utilization after 2015. Younger age, medial/central quadrant, PR-negative and node-positive disease predicted for receipt of IMNI. Modern RT techniques permit the safe delivery of IMNI.

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Title: Utilization patterns and temporal trends of internal mammary nodal irradiation at a tertiary cancer center
Authors: Shagun Misra
Grace Lee
Manjula Maganti
C. Anne Koch
Publication date: 01-07-2020
Publisher: Springer US
Keywords: Mastectomy
Breast Cancer
Breast Cancer
Published in: Breast Cancer Research and Treatment / Issue 2/2020
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05708-0

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