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Open Access 01-11-2014 | Breast Oncology

Breast Radiotherapy (RT) Using Tangential Fields (TgF): A Prospective Evaluation of the Dose Distribution in the Sentinel Lymph Node (SLN) Area as Determined Intraoperatively by Clip Placement

Authors: Yazid Belkacemi, MD, PhD, Veronique Bigorie, MD, Qiong PAN, MD, Ryan Bouaita, MD, Frederic Pigneur, MD, Emmanuel Itti, MD, PhD, Hakima Badaoui, MD, Elias Assaf, MD, Philippe Caillet, MD, Elie Calitchi, MD, Romain Bosc, MD

Published in: Annals of Surgical Oncology | Issue 12/2014

Abstract

Background

Randomized trials have established that patients with limited involvement of sentinel lymph node (SLN) do not require axillary lymph node dissection (ALND). The similar outcome in patients with ≤2 positive SLN with or without additional ALND is attributed, in part, to tangential fields (TgF) RT. We evaluated the dose distribution in the SLN biopsy area (SLNBa) as determined intraoperatively by clips placement for radiotherapy (RT) optimization.

Methods

This prospective study included 25 patients who had breast conservation. Titanium clips were used intraoperatively to mark the SLNBa. All patients had 3D-conformal RT using standard (STgF) or high tangential fields (HTgF). Axillary levels, SLNBa, and organs at risk were contoured on a CT scan. Dose distribution and overlap between TgF and target volumes were analyzed.

Results

The average doses delivered to axilla levels I-III and SLNBa were 25, 5, 2, and 33 Gy, respectively. The average dose delivered to SLNBa was higher using HTgF with better coverage of the axilla. Only 12 of 25 patients (48 %) had their SLNBa completely covered by the TgF. There was no impact of TgF size on ipsilateral lung dose. The mean heart dose delivered using STgF was lower than HTgF.

Conclusions

In the era of SLNB, axilla and SNLBa RT technique has to be standardized to deliver adequate dose. We recommend the use of HTgF or direct axillary RT techniques (such as in AMAROS trial) in patients with metastases in SLN without ALND completion, when only TgF are expected to cure potential residual disease in the axilla.

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Title: Breast Radiotherapy (RT) Using Tangential Fields (TgF): A Prospective Evaluation of the Dose Distribution in the Sentinel Lymph Node (SLN) Area as Determined Intraoperatively by Clip Placement
Authors: Yazid Belkacemi, MD, PhD
Veronique Bigorie, MD
Qiong PAN, MD
Ryan Bouaita, MD
Frederic Pigneur, MD
Emmanuel Itti, MD, PhD
Hakima Badaoui, MD
Elias Assaf, MD
Philippe Caillet, MD
Elie Calitchi, MD
Romain Bosc, MD
Publication date: 01-11-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 12/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3966-1

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Breast Radiotherapy (RT) Using Tangential Fields (TgF): A Prospective Evaluation of the Dose Distribution in the Sentinel Lymph Node (SLN) Area as Determined Intraoperatively by Clip Placement

Abstract

Background

Methods

Results

Conclusions

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Abstract

Background

Methods

Results

Conclusions

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