Radiation Oncology Journal

  • 제33권1호
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  • Pages.50-56
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  • 2015
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  • 2234-1900(pISSN)
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  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
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Virtual lymph node analysis to evaluate axillary lymph node coverage provided by tangential breast irradiation

  • Park, Shin-Hyung (Department of Radiation Oncology, Kyungpook National University Hospital) ;
  • Kim, Jae-Chul (Department of Radiation Oncology, Kyungpook National University Hospital) ;
  • Lee, Jeong Eun (Department of Radiation Oncology, Kyungpook National University Hospital) ;
  • Park, In-Kyu (Department of Radiation Oncology, Kyungpook National University Hospital)
  • 투고 : 2014.12.30
  • 심사 : 2015.03.02
  • 발행 : 2015.03.31
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초록

Purpose: To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. Materials and Methods: Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. Results: The median level I and II axillary volume coverage percentages at the $V_{D95%}$ line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. Conclusion: The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary.

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참고문헌

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  1. Coverage of Axillary Lymph Nodes with Tangential Breast Irradiation in Korea: A Multi-Institutional Comparison Study vol.2016, pp.None, 2016, https://doi.org/10.1155/2016/8576357
  2. Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer vol.48, pp.4, 2015, https://doi.org/10.4143/crt.2015.463
  3. Meeting Highlights: The Second Consensus Conference for Breast Cancer Treatment in Korea vol.20, pp.3, 2015, https://doi.org/10.4048/jbc.2017.20.3.228
  4. Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer vol.13, pp.16, 2015, https://doi.org/10.3390/cancers13164044