Irradiation of Lymph Nodes Areas in Breast Cancer

[lymphede...@gmail.com]

Irradiation of lymph nodes areas in breast cancer

Cancer Radiother. 2008 Oct 16

Hennequin C, Romestaing P, Maylin C.
Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue
Claude-Vellefeaux, 75010 Paris, France.

Postoperative radiotherapy after breast surgery increases overall
survival by decreasing the local relapse rate. The main site of
relapse is the breast or the chest wall. The value of irradiation of
the nodal basins is still discussed. It must be emphasized that nodal
areas were systematically irradiated in the postmastectomy randomized
trials demonstrating a benefit in survival for adjuvant radiotherapy.
Axillary relapses are infrequent in case of complete axillary
dissection; complementary irradiation could be proposed if the
axillary dissection is incomplete or if there is a massive pathologic
involvement of the axilla. Its main complication is lymphoedema, which
remains the most frequent sequellae of the treatment of breast cancer.
Supraclavicular irradiation is logical in case of axillary
involvement. Internal mammary nodes are involved in 20 to 40% of the
patients, depending of the axillary involvement and location of the
tumor inside the breast. Irradiation of the internal mammary basin is
difficult: optimal dosimetry required a CT-based simulation. Its
benefit remains to be proved. Internal mammary nodes irradiation
probably increased cardiovascular mortality. Sophisticated techniques
are needed to spare the heart from irradiation. Two large randomized
trials (French group, European Organization for Research and Treatment
of Cancer [EORTC]) are currently evaluating the possible benefit of
internal mammary irradiation.

PMID: 18951822 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/18951822?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum