Axillary Lymph Node Coverage in Breast Cancer Patients Treated with Adjuvant Radiation Using High Tangent Fields Technique: A Single Institution’s Experience High tangent adjuvant radiotherapy

Lindsay Booth (1), Timothy Kong (2), Ajhmair Lali (3), Angela Lin (4), François Germain (5), Sarah Lucas (6), Rasika Rajapakshe (7), Siavash Atrchian (8)
(1) Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada, Canada,
(2) Division of Radiation Oncology and Developmental Radiotherapeutics, Department of Surgery Faculty of Medicine, University of British Columbia, Vancouver, Canada; BC Cancer - Vancouver, Canada, Canada,
(3) Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada, Canada,
(4) Division of Radiation Oncology and Developmental Radiotherapeutics, Department of Surgery Faculty of Medicine, University of British Columbia, Vancouver, Canada; BC Cancer - Kelowna, Canada, Canada,
(5) Division of Radiation Oncology and Developmental Radiotherapeutics, Department of Surgery Faculty of Medicine, University of British Columbia, Vancouver, Canada; BC Cancer - Kelowna, Canada, Canada,
(6) Division of Radiation Oncology and Developmental Radiotherapeutics, Department of Surgery Faculty of Medicine, University of British Columbia, Vancouver, Canada; BC Cancer - Kelowna, Canada, Canada,
(7) Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada; BC Cancer - Kelowna, Canada; Computer Science, UBC Okanagan, Kelowna, Canada, Canada,
(8) Division of Radiation Oncology and Developmental Radiotherapeutics, Department of Surgery Faculty of Medicine, University of British Columbia, Vancouver, Canada; BC Cancer- Kelowna, Canada, Canada

Abstract

Background: The high tangent field (HTF) technique is used to provide radiation coverage of the inferior axillary nodal levels for breast cancer patients when the lower axilla is at risk for micrometastatic disease. Despite its use in clinical practice, there is concern about whether HTF provide sufficient coverage of level I and II axillary nodal regions. The purpose of this study is to quantify and evaluate the coverage of HTF at our institution.


Methods: Patients diagnosed with early invasive breast carcinoma (pT1-2 pN0-1a) who received HTF radiation between January 1st, 2012 and December 31st, 2016 were retrospectively reviewed. Level I and II axillary nodal regions were contoured on each patient’s simulation CT. Dosimetric parameters were re-calculated to evaluate coverage. Statistical analysis was conducted using Mann-Whitney-U method. 


Results: Thirty-seven patients with low-risk breast adenocarcinoma were included. For level I and II, the mean V90% was 94.63% ± 7.60% and 73.33% ± 21.83% respectively. Twenty-nine patients received adequate V90% coverage of level I and had a mean level II V90% of 76% ± 18.71% while eight patients who did not receive adequate V90% level I coverage had a mean level II V90% of 63.64% ± 30.22%. The median level II V90% of patients receiving adequate and inadequate level I V90% was 77.74% and 71.11% respectively; the difference was not statistically significant (P = 0.33).


Conclusion: HTF provides adequate coverage for level I nodes, but inadequate coverage for level II. Contouring nodal volumes may assist field placement and improve nodal volume coverage.

Full text article

Generated from XML file

References

Brenner DR, Weir HK, Demers AA, Ellison LF, Louzado C, Shaw A, et al. Projected estimates of cancer in Canada in 2020. CMAJ. 2020;192:E199-E205. doi:10.1503/cmaj.191292

Lyman GH, Giuliano AE, Somerfield MR, Benson AB, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer. J Clin Oncol. 2005;23:7703-7720. doi: 10.1200/JCO.2005.08.001.

Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426-433. doi: 10.1097/SLA.0b013e3181f08f32.

Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary Dissection vs No Axillary Dissection in Women with Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Clinical Trial. JAMA. 2011;305:569-575. doi: 10.1001/jama.2011.90.

Giuliano AE, Ballman K, McCall L, Beitsch P, Whitworth PW, Blumencranz P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: Long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg. 2016;264:413-420. doi: doi.org/10.1097/SLA.0000000000001863.

Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJH, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomized, multicenter, open-label, phase 3 non-inferiority trial. Lanc Oncol. 2014;15:1303–1310. doi: 10.1016/S1470-2045(14)70460-7

Gradishar WJ, Moran MS, Abraham J, Abramson V, Aft R, Agnese D, et al. NCCN Guidelines® Insights: Breast Cancer, Version 5.2023: Featured Updates to the NCCN Guidelines. J Natl Compr Canc Netw. 2023 Jun;21(6):594-608. doi: 10.6004/jnccn.2023.0031

Schlembach PJ, Buchholz TA, Ross MI, Kirsner SM, Salas GJ, Strom EA, et al. Relationship of sentinel and axillary level I-II lymph nodes to tangential fields used in breast irradiation. Int J Radiat Oncol Biol Phys. 2001;51:671-678. doi: 10.1016/S0360-3016(01)01684-4.

Reed DR, Lindsley SK, Mann GN, Austin-Seymour M, Korssjen T, Anderson B, et al. Axillary lymph node dose with tangential breast irradiation. Int J Radiat Oncol Biol Phys. 2005;61:358–64. doi: doi: 10.1016/j.ijrobp.2004.06.006.

Reznik J, Cicchetti MG, Degaspe B, Fitzgerald TJ. Analysis of axillary coverage during tangential radiation therapy to the breast. Int J Radiat Oncol Biol Phys. 2005;61:163–8. doi: 10.1016/j.ijrobp.2004.06.006.

Jagsi R, Chadha M, Moni J, Ballman K, Laurie F, Buchholz TA, et al. Radiation field design in the ACOSOG Z0011 (Alliance) Trial. J Clin Oncol. 2014;32:3600-3606. doi: 10.1200/JCO.2014.56.5838.

Nagar H, Zhou L, Biritz B, Sison C, Chang J, Smith M, et al. Is There a Tradeoff in Using Modified High Tangent Field Radiation for Treating an Undissected Node-Positive Axilla? Clin Breast Cancer. 2014;14:109–113. doi: 10.1016/j.clbc.2013.10.004.

Azghadi S, Daly ME, Mayadev JS. Practice patterns of radiation field design for sentinel lymph node positive early-stage breast cancer. Int J Radiat Oncol Biol Phys. 2015;93:E17-E18. doi: 10.1016/j.clbc.2016.05.009.

O’Sullivan S, Rock K, ElBeltagi N. Radiotherapy in sentinel node-positive breast cancer: results of an international survey. J of Radiother Pract. 2016;15:247-253. doi: 10.1017/S1460396916000170.

Alço G, Iğdem SI, Ercan T, Dinger M, Entürk RS, Atilla S, et al. Coverage of axillary lymph nodes with high tangential fields in breast radiotherapy. Bri J Radiol. 2010;83(996):1072–1076. doi: 10.1259/bjr/25788274.

Shah C, Wilkinson JB, Baschnagel A, Ghilezan M, Riutta J, Dekhne N, et al. Factors associated with the development of breast cancer–related lymphedema after whole-breast irradiation. Int J Radiat Oncol Biol Phys. 2012;83(4):1095-1100. doi: 10.1016/j.ijrobp.2011.09.058.

Whelan TJ, Olivotto I, Ackerman I, Chapman JW, Chua B, Nabid A, et al. NCIC-CTG MA. 20: an intergroup trial of regional nodal irradiation in early breast cancer. J Clin Oncol. 2011;29(18_suppl):LBA1003-LBA1003. doi: 10.1200/jco.2011.29.18_suppl.lba1003.

Wang S, Kirova YM, Shan S-C, Cai G, Ou D, Cao L, et al. Different radiation techniques to deliver therapeutic dose to the axilla in patients with sentinel lymph node-positive breast cancer: Doses, techniques challenges and clinical considerations. Cancer Radiother. 2018;22:767–772. doi: 10.1016/j.canrad.2018.02.002.

Malouff TD, Vallow LA, Magalhaes WL, Seneviratne DS, Waddle MR, Tzou KS. Dosimetric analysis of axillary lymph node coverage using high tangents in the prone position for left-sided breast cancers. Cureus. 2022;14(3):e23613. doi: 10.7759/cureus.23613

Tanaka H, Ito M, Yamaguchi T, Hachiya K, Yajima T, Kitahara M, et al. High tangent radiation therapy with field-infield technique for breast cancer. Breast Cancer: Basic Clin Res. 2017;11:1-5. doi: 10.1177/1178223417731297.

Authors

Lindsay Booth
Timothy Kong
Ajhmair Lali
Angela Lin
François Germain
Sarah Lucas
Rasika Rajapakshe
Siavash Atrchian
siavash.atrchian@ubc.ca (Primary Contact)
1.
Booth L, Kong T, Lali A, Lin A, Germain F, Lucas S, Rajapakshe R, Atrchian S. Axillary Lymph Node Coverage in Breast Cancer Patients Treated with Adjuvant Radiation Using High Tangent Fields Technique: A Single Institution’s Experience: High tangent adjuvant radiotherapy. Arch Breast Cancer [Internet]. 2024 Jan. 31 [cited 2024 Feb. 22];11(1):75-81. Available from: https://archbreastcancer.com/index.php/abc/article/view/848

Article Details

Similar Articles

1 2 3 > >> 

You may also start an advanced similarity search for this article.