Radiotherapy of the regional lymph nodes: shooting at the sheriff?
Identifieur interne : 006066 ( Main/Exploration ); précédent : 006065; suivant : 006067Radiotherapy of the regional lymph nodes: shooting at the sheriff?
Auteurs : Ian H. Kunkler [Royaume-Uni]Source :
- Breast (Edinburgh, Scotland) [ 1532-3080 ] ; 2009.
Descripteurs français
- KwdFr :
- Biopsie de noeud lymphatique sentinelle, Femelle, Humains, Irradiation ganglionnaire, Lymphadénectomie, Mastectomie, Métastase lymphatique (), Métastase lymphatique (radiothérapie), Noeuds lymphatiques (), Noeuds lymphatiques (anatomopathologie), Radiothérapie (), Radiothérapie (effets indésirables), Radiothérapie adjuvante, Tumeurs du sein (), Tumeurs du sein (anatomopathologie), Tumeurs du sein (radiothérapie).
- MESH :
- anatomopathologie : Noeuds lymphatiques, Tumeurs du sein.
- effets indésirables : Radiothérapie.
- radiothérapie : Métastase lymphatique, Tumeurs du sein.
- Biopsie de noeud lymphatique sentinelle, Femelle, Humains, Irradiation ganglionnaire, Lymphadénectomie, Mastectomie, Métastase lymphatique, Noeuds lymphatiques, Radiothérapie, Radiothérapie adjuvante, Tumeurs du sein.
English descriptors
- KwdEn :
- Breast Neoplasms (pathology), Breast Neoplasms (radiotherapy), Breast Neoplasms (surgery), Female, Humans, Lymph Node Excision, Lymph Nodes (pathology), Lymph Nodes (surgery), Lymphatic Irradiation, Lymphatic Metastasis (prevention & control), Lymphatic Metastasis (radiotherapy), Mastectomy, Radiotherapy (adverse effects), Radiotherapy (methods), Radiotherapy, Adjuvant, Sentinel Lymph Node Biopsy.
- MESH :
- adverse effects : Radiotherapy.
- methods : Radiotherapy.
- pathology : Breast Neoplasms, Lymph Nodes.
- prevention & control : Lymphatic Metastasis.
- radiotherapy : Breast Neoplasms, Lymphatic Metastasis.
- surgery : Breast Neoplasms, Lymph Nodes.
- Female, Humans, Lymph Node Excision, Lymphatic Irradiation, Mastectomy, Radiotherapy, Adjuvant, Sentinel Lymph Node Biopsy.
Abstract
The role of immune surveillance in controlling the spread of breast cancer to the regional nodes is poorly understood. In theory regional nodal irradiation (RNI) might compromise this host function. However the clinical evidence suggests that the risk of regional recurrence is lower in patients with early breast cancer whose axilla has been irradiated compared to no axillary treatment. The role of RNI after breast conserving surgery has not been well studied. A policy of level III clearance and only irradiating the axilla for residual disease and a selective policy of axillary irradiation in node positive patients after sentinel node biopsy or lower axillary node sample is recommended. Irradiation of the medial supraclavicular fossa after axillary dissection is suggested where there are four or more nodes involved on axillary dissection. There is little data to inform selection of patients for RNI after neoadjuvant systemic therapy. The role of postmastectomy radiotherapy (PMRT) was largely established on the basis of comprehensive RNI. It is unclear whether irradiating less than the chest wall and peripheral lymphatics confers the same level of benefit. The role of PMRT in women with 1-3 involved nodes remains controversial and investigational. Biological factors such as oestrogen and progesterone receptor status and HER-2 protein expression may play a role in determining benefits from PMRT. The role of internal mammary nodal irradiation is unclear. The individualisation of RNI based on molecular and genetic factors should be a priority for research. The benefits of RNI need to be carefully balanced against the risks of cardiotoxicity, pneumonitis, lymphoedema, brachial plexopathy and secondary malignancy.
DOI: 10.1016/S0960-9776(09)70285-1
PubMed: 19914529
Affiliations:
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I.Kunkler@ed.ac.uk</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Edinburgh Cancer Centre, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, Scotland</wicri:regionArea><orgName type="university">Université d'Édimbourg</orgName><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2009">2009</date><idno type="RBID">pubmed:19914529</idno><idno type="pmid">19914529</idno><idno type="doi">10.1016/S0960-9776(09)70285-1</idno><idno type="wicri:Area/PubMed/Corpus">002C79</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">002C79</idno><idno type="wicri:Area/PubMed/Curation">002C79</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">002C79</idno><idno type="wicri:Area/PubMed/Checkpoint">002C79</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">002C79</idno><idno type="wicri:Area/Ncbi/Merge">003730</idno><idno type="wicri:Area/Ncbi/Curation">003730</idno><idno type="wicri:Area/Ncbi/Checkpoint">003730</idno><idno type="wicri:Area/Main/Merge">006138</idno><idno type="wicri:Area/Main/Curation">006066</idno><idno type="wicri:Area/Main/Exploration">006066</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Radiotherapy of the regional lymph nodes: shooting at the sheriff?</title><author><name sortKey="Kunkler, Ian H" sort="Kunkler, Ian H" uniqKey="Kunkler I" first="Ian H" last="Kunkler">Ian H. Kunkler</name><affiliation wicri:level="4"><nlm:affiliation>Edinburgh Cancer Centre, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, Scotland, UK. I.Kunkler@ed.ac.uk</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Edinburgh Cancer Centre, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, Scotland</wicri:regionArea><orgName type="university">Université d'Édimbourg</orgName><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region></placeName></affiliation></author></analytic><series><title level="j">Breast (Edinburgh, Scotland)</title><idno type="eISSN">1532-3080</idno><imprint><date when="2009" type="published">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Breast Neoplasms (pathology)</term><term>Breast Neoplasms (radiotherapy)</term><term>Breast Neoplasms (surgery)</term><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Lymph Nodes (pathology)</term><term>Lymph Nodes (surgery)</term><term>Lymphatic Irradiation</term><term>Lymphatic Metastasis (prevention & control)</term><term>Lymphatic Metastasis (radiotherapy)</term><term>Mastectomy</term><term>Radiotherapy (adverse effects)</term><term>Radiotherapy (methods)</term><term>Radiotherapy, Adjuvant</term><term>Sentinel Lymph Node Biopsy</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Biopsie de noeud lymphatique sentinelle</term><term>Femelle</term><term>Humains</term><term>Irradiation ganglionnaire</term><term>Lymphadénectomie</term><term>Mastectomie</term><term>Métastase lymphatique ()</term><term>Métastase lymphatique (radiothérapie)</term><term>Noeuds lymphatiques ()</term><term>Noeuds lymphatiques (anatomopathologie)</term><term>Radiothérapie ()</term><term>Radiothérapie (effets indésirables)</term><term>Radiothérapie adjuvante</term><term>Tumeurs du sein ()</term><term>Tumeurs du sein (anatomopathologie)</term><term>Tumeurs du sein (radiothérapie)</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Radiotherapy</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Noeuds lymphatiques</term><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Radiothérapie</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Radiotherapy</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Breast Neoplasms</term><term>Lymph Nodes</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Lymphatic Metastasis</term></keywords><keywords scheme="MESH" qualifier="radiotherapy" xml:lang="en"><term>Breast Neoplasms</term><term>Lymphatic Metastasis</term></keywords><keywords scheme="MESH" qualifier="radiothérapie" xml:lang="fr"><term>Métastase lymphatique</term><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term><term>Lymph Nodes</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Lymphatic Irradiation</term><term>Mastectomy</term><term>Radiotherapy, Adjuvant</term><term>Sentinel Lymph Node Biopsy</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Biopsie de noeud lymphatique sentinelle</term><term>Femelle</term><term>Humains</term><term>Irradiation ganglionnaire</term><term>Lymphadénectomie</term><term>Mastectomie</term><term>Métastase lymphatique</term><term>Noeuds lymphatiques</term><term>Radiothérapie</term><term>Radiothérapie adjuvante</term><term>Tumeurs du sein</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The role of immune surveillance in controlling the spread of breast cancer to the regional nodes is poorly understood. In theory regional nodal irradiation (RNI) might compromise this host function. However the clinical evidence suggests that the risk of regional recurrence is lower in patients with early breast cancer whose axilla has been irradiated compared to no axillary treatment. The role of RNI after breast conserving surgery has not been well studied. A policy of level III clearance and only irradiating the axilla for residual disease and a selective policy of axillary irradiation in node positive patients after sentinel node biopsy or lower axillary node sample is recommended. Irradiation of the medial supraclavicular fossa after axillary dissection is suggested where there are four or more nodes involved on axillary dissection. There is little data to inform selection of patients for RNI after neoadjuvant systemic therapy. The role of postmastectomy radiotherapy (PMRT) was largely established on the basis of comprehensive RNI. It is unclear whether irradiating less than the chest wall and peripheral lymphatics confers the same level of benefit. The role of PMRT in women with 1-3 involved nodes remains controversial and investigational. Biological factors such as oestrogen and progesterone receptor status and HER-2 protein expression may play a role in determining benefits from PMRT. The role of internal mammary nodal irradiation is unclear. The individualisation of RNI based on molecular and genetic factors should be a priority for research. The benefits of RNI need to be carefully balanced against the risks of cardiotoxicity, pneumonitis, lymphoedema, brachial plexopathy and secondary malignancy.</div></front></TEI><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Écosse</li></region><settlement><li>Édimbourg</li></settlement><orgName><li>Université d'Édimbourg</li></orgName></list><tree><country name="Royaume-Uni"><region name="Écosse"><name sortKey="Kunkler, Ian H" sort="Kunkler, Ian H" uniqKey="Kunkler I" first="Ian H" last="Kunkler">Ian H. Kunkler</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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