Radiation Therapy for Breast Cancer: Re-Treatment

Radiation therapy is an established form of therapy for breast cancer, often applied in an adjuvant setting delivered in a post-operative environment to volumes including the breast, surgical cavity, and regional lymph nodes when appropriate. Historically, radiation therapy has not been considered an option for care when the patient recurs with the disease despite being treated with radiation therapy in the adjuvant setting. However, there can be clinical circumstances that require a different approach to the care including comprehensive re-treatment with radiation therapy in highly selected situations. This paper reviewed two patients with clinical circumstances requiring consideration for re-treatment with radiation therapy and were successfully re-treated with an acceptable outcome.

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Modern view on the issues of diagnosis and verification of axillary lymph nodes involvement in early breast cancer

Modern Oncology ◽

10.26442/18151434.2020.1.200018 ◽

2020 ◽

Vol 22 (1) ◽

pp. 46-52

Author(s):

Irina V. Kolyadina ◽

Tatiana Yu. Danzanova ◽

Svetlana V. Khokhlova ◽

Oksana P. Trofimova ◽

Ekaterina V. Kovaleva ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Lymph Node ◽

Lymph Nodes ◽

Early Breast Cancer ◽

Regional Lymph Node ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

High Quality ◽

Regional Lymph Nodes

The involvement of axillary lymph nodes is one of the most important prognostic factors, significantly affecting the treatment strategy for early breast cancer (BC). The risk of axillary lymph node metastases depends directly on a number of factors (age of women, size of tumor, presence of lymphovascular invasion and biological characteristics of cancer). The evaluation of regional lymph node status in patients with early BC includes the clinical examination of regional zones and the ultrasound study (US), using these methods can help to study lymph nodes shape, borders, margins and structure. The sensitivity of ultrasound in the evaluation of regional lymph nodes status directly depends on the biological subtype of the tumor; the minimum level of ultrasound sensitivity in the evaluation of lymph nodes status is detected for luminal HER2-negative cancer (less than 40%), and maximum sensitivity is detected for triple negative and HER2-positive subtypes (6871%). Clinical examination and modern ultrasound are the most accessible methods for the evaluation of regional lymph nodes status, but the possibility to misjudge metastatic process can be detected in 1/4 of patients. Verification of the diagnosis in the preoperative phase (fine-needle aspiration biopsy/core-needle biopsy under ultrasound guidance) allows minimize the number of errors for the regional staging. The sentinel lymph node biopsy (SLNB) is the gold standard of regional treatment in patients with early stage BC, nowadays. The randomized trials (NSABP B-32, ACOSOG q0011) show the safety of recession of performing regional lymph node dissection in favor of SLNB not only in case of clinically negative lymph nodes, but also in patients with metastases in 2 sentinel lymph nodes, upon condition that organ-conservative treatment and subsequent radiation therapy will be used. High-quality regional staging, the choice of the therapeutic algorithm in accordance with the biological characteristics of carcinoma, the application of the most effective modern drug regimes, the optimal radiation therapy allow not only minimize the extent of surgery, but also achieve high long-term survival results, provide excellent functional results and high quality of life in patients with the involvement of axillary lymph nodes.

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Treatment of Regional Lymph Nodes in Breast Cancer—Evidence in Favor of Radiation Therapy

JAMA Oncology ◽

10.1001/jamaoncol.2016.0183 ◽

2016 ◽

Vol 2 (8) ◽

pp. 989 ◽

Cited By ~ 6

Author(s):

Philip M. P. Poortmans ◽

Charlotte Coles ◽

Jacques Bernier

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Lymph Nodes ◽

Regional Lymph Nodes

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Adjuvant radiation therapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials- an update

Radiation Oncology ◽

10.1186/s13014-015-0568-4 ◽

2015 ◽

Vol 10 (1) ◽

Cited By ~ 51

Author(s):

Wilfried Budach ◽

Edwin Bölke ◽

Kai Kammers ◽

Peter Arne Gerber ◽

Carolin Nestle-Krämling ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Lymph Nodes ◽

Randomized Trials ◽

Meta Analysis ◽

Adjuvant Radiation ◽

Regional Lymph Nodes ◽

Adjuvant Radiation Therapy

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Breast Cancer Clinical Regional Lymph Nodes TNM Finding v8

10.32388/akyy54 ◽

2020 ◽

Author(s):

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Regional Lymph Nodes

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THE ROLE OF SURGICAL STAGE IN COMBINATION THERAPY FOR PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER

Problems in oncology ◽

10.37469/0507-3758-2019-65-5-749-755 ◽

2019 ◽

Vol 65 (5) ◽

pp. 749-755

Author(s):

D. Reyes Santyago ◽

Anzhella Khadzhimba ◽

M. Smirnova ◽

Sergey Maksimov

Keyword(s):

Cervical Cancer ◽

Radiation Therapy ◽

Combination Therapy ◽

Lymph Nodes ◽

Locally Advanced ◽

Advanced Cervical Cancer ◽

Relapse Free Survival ◽

Regional Lymph Nodes ◽

Free Survival ◽

Locally Advanced Cervical Cancer

Objective: to justify the expediency of the surgical stage as a part of the combination treatment for stage IIA-IIIB cervical cancer. Materials and methods. The study included 343 women with stage IIA-IIIB cervical cancer treated from 2013 to 2016 with mandatory follow-up for at least 2 years. Patients were divided into 2 groups. The first group included 214 patients who received a combination treatment. At the first stage, neoadjuvant chemoradiation therapy was performed (remote radiation therapy 5 days a week with radio modification with Cisplatin once a week at a dose of 40 mg/m2). After evaluating the effect, patients were subjected to surgical treatment or continued chemoradiotherapy. The second group (n = 129) received standard combined radiation therapy. Various schemes of combination and complex treatment and standard combined radiation therapy were evaluated using the indices of general and relapse-free survival. Results. The proposed scheme for the combination therapy for patients with locally advanced cervical cancer showed significantly higher survival rates at all the analyzed stages. For the combined treatment group with complete cytoreduction, the two-year overall and relapse-free survival with stage IIA is 94.1% vs. 82.4%, with IIB 90.8% vs. 80.3%, with IIB 87.5% vs. 75%, with IIB with metastatic lesion of regional lymph nodes 85% vs. 70%. For the second group, two-year overall and relapse-free survival with stage IIA 75% vs. 50%, with IIB 70.9% vs. 56.3%, with IIB 59.1% vs. 40.9%, with IIB with metastatic lesion of regional lymph nodes 62.2% and 40.5%. The advantages of this approach are most clearly seen within patients with metastatic lesions of regional lymph nodes (85% vs. 62% accordingly). Conclusion. Cytoreductive surgery in combination with the combination therapy allows to achieve a significant increase in overall and relapse-free survival for patients with locally advanced cervical cancer compared with standard treatment programs.

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Hybrid volumetric-modulated arc therapy for postoperative breast cancer including regional lymph nodes: the advantage of dosimetric data and safety of toxicities

Journal of Radiation Research ◽

10.1093/jrr/rraa057 ◽

2020 ◽

Vol 61 (5) ◽

pp. 747-754

Author(s):

Yoshiko Doi ◽

Minoru Nakao ◽

Hideharu Miura ◽

Shuichi Ozawa ◽

Masahiro Kenjo ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Irradiation Dose ◽

Organs At Risk ◽

Volumetric Modulated Arc Therapy ◽

Conformity Index ◽

Regional Lymph Nodes ◽

Dosimetric Data ◽

Arc Therapy

ABSTRACT To improve the homogeneity and conformity of the irradiation dose for postoperative breast cancer including regional lymph nodes, we planned Hybrid volumetric-modulated arc therapy (VMAT), which combines conventional tangential field mainly for the chest area and VMAT mainly for the supraclavicular area and marginal zone. In this study, we compared the dosimetric impact between traditional 3D conformal radiotherapy (3DCRT) and Hybrid VMAT and observed toxicities following Hybrid VMAT. A total of 70 patients indicated between October 2016 and December 2017 were included. The prescribed dose was 50 Gy/25 fractions. For the dosimetric impact, 3DCRT and Hybrid VMAT plans were compared in each patient with respect to the dosimetric parameters. Toxicities were followed using the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up duration was 319 days. For the dosimetric impact, the homogeneity index (HI) and conformity index (CI) of PTV were significantly improved in the Hybrid VMAT plan compared with that in the 3DCRT plan (HI, 0.15 ± 0.07 in Hybrid VMAT vs 0.41 ± 0.19 in 3DCRT, P < 0.001; CI, 1.61 ± 0.44 in Hybrid VMAT vs 2.10 ± 0.56 in 3DCRT, P < 0.001). The mean irradiated ipsilateral lung dose was not significantly different in both plans (12.0 ± 2.4 Gy in Hybrid VMAT vs 11.8 ± 2.8 Gy in 3DCRT, P < 0.533). Regarding toxicity, there were no patients who developed ≥grade 3 acute toxicity and ≥grade 2 pneumonitis during the follow-up. Hybrid VMAT for postoperative breast cancer including regional lymph nodes was a reasonable technique that improved the homogeneity and conformity of the irradiation dose to the planning target volume while keeping the irradiation dose to organs at risk to a minimum.

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Surgical component of lateral and central breast cancer treatment

Kazan medical journal ◽

10.17816/kmj2021-479 ◽

2021 ◽

Vol 102 (4) ◽

pp. 479-485

Author(s):

Z M Abdurakhmanova ◽

M R Ramazanov ◽

E I Sigal

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Oxygen Saturation ◽

Cancer Treatment ◽

Comparison Group ◽

Breast Cancer Treatment ◽

Main Group ◽

Regional Lymph Nodes ◽

Hemoglobin Oxygen Saturation ◽

Arterial Blood

Aim. To improve the results of the surgical component in the treatment of a nodular form of breast cancer with lateral and central localization by analyzing hemoglobin oxygen saturation of arterial blood in the foci of breast cancer, regional lymph nodes and resection line of the breast. Methods. The study involved 175 patients with a nodular form of breast cancer with lateral and central localization (T23N12M0), including 86 in the main group and 89 in the comparison group. In the main group, hemoglobin oxygen saturation in arterial blood of the foci of breast cancer, parenchyma, pectoral muscles and regional lymph nodes was examined for spread of cancer during surgery for nodular breast cancer by using a device developed by us (patent RU 2581266). This examination was not performed in the comparison group. Histopathological examination of resection specimens revealed confirmation of the main foci of breast cancer and the presence of metastases in the regional lymph nodes and pectoral muscles of the breast. Statistical analysis of the data was performed by using the Statistica 10 software. The arithmetic mean, the standard error of the mean and the standard deviation were calculated for the quantitative indicators. Results. In the main group, 86 patients had no recurrence and metastases in the follow-up, while in the comparison group, cancer recurrence was identified in 89 patients and metastases was found during cytological and histological studies in 9 patients. Conclusion. Determination of hemoglobin oxygen saturation of arterial blood during surgery in the subclavian, axillary and subscapular lymph nodes as well as in the pectoralis major and minor muscles allows clarifying the distribution of breast cancer, specifying the scope of the operation and improving the results of the surgical component of breast cancer treatment (T23N12M0).

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Clinical, morphological, and molecular genetic predictors of metastatic lesions in the regional lymph nodes in breast cancer

Advances in molecular oncology ◽

10.17650/2313-805x-2018-5-3-8-16 ◽

2018 ◽

Vol 5 (3) ◽

pp. 8-16

Author(s):

Yu. A. Dergunova ◽

V. V. Podionov ◽

V. K. Bozhenko ◽

V. V. Kometova ◽

M. V. Dardyk

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Molecular Genetic ◽

Regional Lymph Nodes ◽

Genetic Characteristics ◽

Metastatic Lesions ◽

Genetic Predictors ◽

Node Metastases ◽

High Degree

Despite the sufficient amount of data accumulated in the literature, there are still no factors, on the basis of which it would be possible to estimate the regional lymph nodes status in breast cancer with a high degree of accuracy. The review presents literature data relating to the influence of clinicopathological, molecular-biological and genetic characteristics of primary tumor on lymph node metastases. Data of 66 foreign and Russian articles are included.

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