Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity
Identifieur interne : 001D00 ( Main/Exploration ); précédent : 001C99; suivant : 001D01Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity
Auteurs : Marina Guenzi [Italie] ; Gladys Blandino [Italie] ; Maria Giuseppina Vidili [Italie] ; Deborah Aloi [Italie] ; Elena Configliacco [Italie] ; Elisa Verzanini [Italie] ; Elena Tornari [Italie] ; Francesca Cavagnetto [Italie] ; Renzo Corv [Italie]Source :
- Radiation Oncology (London, England) [ 1748-717X ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Aisselle, Association thérapeutique, Complications postopératoires (épidémiologie), Complications postopératoires (étiologie), Femelle, Humains, Hypofractionnement de dose, Lymphadénectomie, Lymphoedème (épidémiologie), Lymphoedème (étiologie), Mastectomie partielle, Métastase lymphatique (anatomopathologie), Métastase lymphatique (radiothérapie), Noeuds lymphatiques (effets des radiations), Planification de radiothérapie assistée par ordinateur, Radiothérapie adjuvante (effets indésirables), Sujet âgé, Sujet âgé de 80 ans ou plus, Traitement médicamenteux adjuvant, Tumeurs du sein (anatomopathologie), Tumeurs du sein (radiothérapie), Études rétrospectives.
- MESH :
- anatomopathologie : Métastase lymphatique, Tumeurs du sein.
- effets des radiations : Noeuds lymphatiques.
- effets indésirables : Radiothérapie adjuvante.
- radiothérapie : Métastase lymphatique, Tumeurs du sein.
- épidémiologie : Complications postopératoires, Lymphoedème.
- étiologie : Complications postopératoires, Lymphoedème.
- Adulte, Adulte d'âge moyen, Aisselle, Association thérapeutique, Femelle, Humains, Hypofractionnement de dose, Lymphadénectomie, Mastectomie partielle, Planification de radiothérapie assistée par ordinateur, Sujet âgé, Sujet âgé de 80 ans ou plus, Traitement médicamenteux adjuvant, Études rétrospectives.
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Axilla, Breast Neoplasms (pathology), Breast Neoplasms (radiotherapy), Chemotherapy, Adjuvant, Combined Modality Therapy, Dose Hypofractionation, Female, Humans, Lymph Node Excision, Lymph Nodes (radiation effects), Lymphatic Metastasis (pathology), Lymphatic Metastasis (radiotherapy), Lymphedema (epidemiology), Lymphedema (etiology), Mastectomy, Segmental, Middle Aged, Postoperative Complications (epidemiology), Postoperative Complications (etiology), Radiotherapy Planning, Computer-Assisted, Radiotherapy, Adjuvant (adverse effects), Retrospective Studies.
- MESH :
- adverse effects : Radiotherapy, Adjuvant.
- epidemiology : Lymphedema, Postoperative Complications.
- etiology : Lymphedema, Postoperative Complications.
- pathology : Breast Neoplasms, Lymphatic Metastasis.
- radiation effects : Lymph Nodes.
- radiotherapy : Breast Neoplasms, Lymphatic Metastasis.
- Adult, Aged, Aged, 80 and over, Axilla, Chemotherapy, Adjuvant, Combined Modality Therapy, Dose Hypofractionation, Female, Humans, Lymph Node Excision, Mastectomy, Segmental, Middle Aged, Radiotherapy Planning, Computer-Assisted, Retrospective Studies.
Abstract
The aim of the present work was to analyse the impact of mild hypofractionated radiotherapy (RT) of infra-supraclavicular lymph nodes after axillary dissection on late toxicity.
From 2007 to 2012, 100 females affected by breast cancer (pT1- T4, pN1-3, pMx) were treated with conservative surgery, Axillary Node Dissection (AND) and loco-regional radiotherapy (whole breast plus infra-supraclavicular fossa). Axillary lymph nodes metastases were confirmed in all women. The median age at diagnosis was 60 years (range 34–83). Tumors were classified according to molecular characteristics: luminal-A 59 pts (59 %), luminal-B 24 pts (24 %), basal-like 10 pts (10 %), Her-2 like 7 pts (7 %). 82 pts (82 %) received hormonal therapy, 9 pts (9 %) neo-adjuvant chemotherapy, 81pts (81 %) adjuvant chemotherapy. All patients received a mild hypofractionated RT: 46 Gy in 20 fractions 4 times a week to whole breast and infra-supraclavicular fossa plus an additional weekly dose of 1,2 Gy to the lumpectomy area. The disease control and treatment related toxicity were analysed in follow-up visits. The extent of lymphedema was analysed by experts in Oncological Rehabilitation.
Within a median follow-up of 50 months (range 19–82), 6 (6 %) pts died, 1 pt (1 %) had local progression disease, 2 pts (2 %) developed distant metastasis and 1 subject (1 %) presented both. In all patients the acute toxicity was mainly represented by erythema and patchy moist desquamation. At the end of radiotherapy 27 pts (27 %) presented lymphedema, but only 10 cases (10 %) seemed to be correlated to radiotherapy. None of the patients showed a severe damage to the brachial plexus, and the described cases of paresthesias could not definitely be attributed to RT. We did not observe symptomatic pneumonitis.
Irradiation of infra-supraclavicular nodes with a mild hypofractionated schedule can be a safe and effective treatment without evidence of a significant increase of lymphedema appearance radiotherapy related.
Url:
DOI: 10.1186/s13014-015-0480-y
PubMed: 26289040
PubMed Central: 4554321
Affiliations:
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San Martino – IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Blandino, Gladys" sort="Blandino, Gladys" uniqKey="Blandino G" first="Gladys" last="Blandino">Gladys Blandino</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Vidili, Maria Giuseppina" sort="Vidili, Maria Giuseppina" uniqKey="Vidili M" first="Maria Giuseppina" last="Vidili">Maria Giuseppina Vidili</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Oncological Rehabilitation – IRCCS A.O.U. San Martino – IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Oncological Rehabilitation – IRCCS A.O.U. San Martino – IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Aloi, Deborah" sort="Aloi, Deborah" uniqKey="Aloi D" first="Deborah" last="Aloi">Deborah Aloi</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Configliacco, Elena" sort="Configliacco, Elena" uniqKey="Configliacco E" first="Elena" last="Configliacco">Elena Configliacco</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Verzanini, Elisa" sort="Verzanini, Elisa" uniqKey="Verzanini E" first="Elisa" last="Verzanini">Elisa Verzanini</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Tornari, Elena" sort="Tornari, Elena" uniqKey="Tornari E" first="Elena" last="Tornari">Elena Tornari</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Cavagnetto, Francesca" sort="Cavagnetto, Francesca" uniqKey="Cavagnetto F" first="Francesca" last="Cavagnetto">Francesca Cavagnetto</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Medical Physics – IRCCS A.O.U. San Martino – IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medical Physics – IRCCS A.O.U. San Martino – IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Corv, Renzo" sort="Corv, Renzo" uniqKey="Corv R" first="Renzo" last="Corv">Renzo Corv</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author></analytic><series><title level="j">Radiation Oncology (London, England)</title><idno type="eISSN">1748-717X</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Axilla</term><term>Breast Neoplasms (pathology)</term><term>Breast Neoplasms (radiotherapy)</term><term>Chemotherapy, Adjuvant</term><term>Combined Modality Therapy</term><term>Dose Hypofractionation</term><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Lymph Nodes (radiation effects)</term><term>Lymphatic Metastasis (pathology)</term><term>Lymphatic Metastasis (radiotherapy)</term><term>Lymphedema (epidemiology)</term><term>Lymphedema (etiology)</term><term>Mastectomy, Segmental</term><term>Middle Aged</term><term>Postoperative Complications (epidemiology)</term><term>Postoperative Complications (etiology)</term><term>Radiotherapy Planning, Computer-Assisted</term><term>Radiotherapy, Adjuvant (adverse effects)</term><term>Retrospective Studies</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Aisselle</term><term>Association thérapeutique</term><term>Complications postopératoires (épidémiologie)</term><term>Complications postopératoires (étiologie)</term><term>Femelle</term><term>Humains</term><term>Hypofractionnement de dose</term><term>Lymphadénectomie</term><term>Lymphoedème (épidémiologie)</term><term>Lymphoedème (étiologie)</term><term>Mastectomie partielle</term><term>Métastase lymphatique (anatomopathologie)</term><term>Métastase lymphatique (radiothérapie)</term><term>Noeuds lymphatiques (effets des radiations)</term><term>Planification de radiothérapie assistée par ordinateur</term><term>Radiothérapie adjuvante (effets indésirables)</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Traitement médicamenteux adjuvant</term><term>Tumeurs du sein (anatomopathologie)</term><term>Tumeurs du sein (radiothérapie)</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Radiotherapy, Adjuvant</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Métastase lymphatique</term><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="effets des radiations" xml:lang="fr"><term>Noeuds lymphatiques</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Radiothérapie adjuvante</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Lymphedema</term><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Breast Neoplasms</term><term>Lymphatic Metastasis</term></keywords><keywords scheme="MESH" qualifier="radiation effects" xml:lang="en"><term>Lymph Nodes</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="épidémiologie" xml:lang="fr"><term>Complications postopératoires</term><term>Lymphoedème</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Complications postopératoires</term><term>Lymphoedème</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Axilla</term><term>Chemotherapy, Adjuvant</term><term>Combined Modality Therapy</term><term>Dose Hypofractionation</term><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Mastectomy, Segmental</term><term>Middle Aged</term><term>Radiotherapy Planning, Computer-Assisted</term><term>Retrospective Studies</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Aisselle</term><term>Association thérapeutique</term><term>Femelle</term><term>Humains</term><term>Hypofractionnement de dose</term><term>Lymphadénectomie</term><term>Mastectomie partielle</term><term>Planification de radiothérapie assistée par ordinateur</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Traitement médicamenteux adjuvant</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The aim of the present work was to analyse the impact of mild hypofractionated radiotherapy (RT) of infra-supraclavicular lymph nodes after axillary dissection on late toxicity.</p></sec><sec><title>Methods</title><p>From 2007 to 2012, 100 females affected by breast cancer (pT1- T4, pN1-3, pMx) were treated with conservative surgery, Axillary Node Dissection (AND) and loco-regional radiotherapy (whole breast plus infra-supraclavicular fossa). Axillary lymph nodes metastases were confirmed in all women. The median age at diagnosis was 60 years (range 34–83). Tumors were classified according to molecular characteristics: luminal-A 59 pts (59 %), luminal-B 24 pts (24 %), basal-like 10 pts (10 %), Her-2 like 7 pts (7 %). 82 pts (82 %) received hormonal therapy, 9 pts (9 %) neo-adjuvant chemotherapy, 81pts (81 %) adjuvant chemotherapy. All patients received a mild hypofractionated RT: 46 Gy in 20 fractions 4 times a week to whole breast and infra-supraclavicular fossa plus an additional weekly dose of 1,2 Gy to the lumpectomy area. The disease control and treatment related toxicity were analysed in follow-up visits. The extent of lymphedema was analysed by experts in Oncological Rehabilitation.</p></sec><sec><title>Results</title><p>Within a median follow-up of 50 months (range 19–82), 6 (6 %) pts died, 1 pt (1 %) had local progression disease, 2 pts (2 %) developed distant metastasis and 1 subject (1 %) presented both. In all patients the acute toxicity was mainly represented by erythema and patchy moist desquamation. At the end of radiotherapy 27 pts (27 %) presented lymphedema, but only 10 cases (10 %) seemed to be correlated to radiotherapy. None of the patients showed a severe damage to the brachial plexus, and the described cases of paresthesias could not definitely be attributed to RT. We did not observe symptomatic pneumonitis.</p></sec><sec><title>Conclusions</title><p>Irradiation of infra-supraclavicular nodes with a mild hypofractionated schedule can be a safe and effective treatment without evidence of a significant increase of lymphedema appearance radiotherapy related.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mcgale, P" uniqKey="Mcgale P">P McGale</name></author><author><name sortKey="Taylor, C" uniqKey="Taylor C">C Taylor</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Sautter Bihl, Ml" uniqKey="Sautter Bihl M">ML Sautter-Bihl</name></author><author><name sortKey="Sedlmayer, F" uniqKey="Sedlmayer F">F Sedlmayer</name></author><author><name sortKey="Budach, W" uniqKey="Budach W">W Budach</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bartelink, H" uniqKey="Bartelink H">H Bartelink</name></author><author><name sortKey="Maingon, P" uniqKey="Maingon P">P Maingon</name></author><author><name sortKey="Poortmans, P" uniqKey="Poortmans P">P Poortmans</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Whelan, Tj" uniqKey="Whelan T">TJ Whelan</name></author><author><name sortKey="Pignol, Jp" uniqKey="Pignol J">JP Pignol</name></author><author><name sortKey="Levine, Mn" uniqKey="Levine M">MN Levine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haviland, Js" uniqKey="Haviland J">JS Haviland</name></author><author><name sortKey="Owen, Jr" uniqKey="Owen J">JR Owen</name></author><author><name sortKey="Dewar, Ja" uniqKey="Dewar J">JA Dewar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Smith, Bd" uniqKey="Smith B">BD Smith</name></author><author><name sortKey="Bentzen, Sm" uniqKey="Bentzen S">SM Bentzen</name></author><author><name sortKey="Correa, Cr" 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Yaprak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jung, Sy" uniqKey="Jung S">SY Jung</name></author><author><name sortKey="Shin, Kh" uniqKey="Shin K">KH Shin</name></author><author><name sortKey="Kim, M" uniqKey="Kim M">M Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chandra, Ra" uniqKey="Chandra R">RA Chandra</name></author><author><name sortKey="Miller, Cl" uniqKey="Miller C">CL Miller</name></author><author><name sortKey="Skolny, Mn" uniqKey="Skolny M">MN Skolny</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yarnold, J" uniqKey="Yarnold J">J Yarnold</name></author><author><name sortKey="Bentzen, Sm" uniqKey="Bentzen S">SM Bentzen</name></author><author><name sortKey="Coles, C" uniqKey="Coles C">C Coles</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haffty, Bg" uniqKey="Haffty B">BG Haffty</name></author><author><name sortKey="Buchholz, Ta" uniqKey="Buchholz T">TA Buchholz</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Italie</li></country></list><tree><country name="Italie"><noRegion><name sortKey="Guenzi, Marina" sort="Guenzi, Marina" uniqKey="Guenzi M" first="Marina" last="Guenzi">Marina Guenzi</name></noRegion><name sortKey="Aloi, Deborah" sort="Aloi, Deborah" uniqKey="Aloi D" first="Deborah" last="Aloi">Deborah Aloi</name><name sortKey="Blandino, Gladys" sort="Blandino, Gladys" uniqKey="Blandino G" first="Gladys" last="Blandino">Gladys Blandino</name><name sortKey="Cavagnetto, Francesca" sort="Cavagnetto, Francesca" uniqKey="Cavagnetto F" first="Francesca" last="Cavagnetto">Francesca Cavagnetto</name><name sortKey="Configliacco, Elena" sort="Configliacco, Elena" uniqKey="Configliacco E" first="Elena" last="Configliacco">Elena Configliacco</name><name sortKey="Corv, Renzo" sort="Corv, Renzo" uniqKey="Corv R" first="Renzo" last="Corv">Renzo Corv</name><name sortKey="Tornari, Elena" sort="Tornari, Elena" uniqKey="Tornari E" first="Elena" last="Tornari">Elena Tornari</name><name sortKey="Verzanini, Elisa" sort="Verzanini, Elisa" uniqKey="Verzanini E" first="Elisa" last="Verzanini">Elisa Verzanini</name><name sortKey="Vidili, Maria Giuseppina" sort="Vidili, Maria Giuseppina" uniqKey="Vidili M" first="Maria Giuseppina" last="Vidili">Maria Giuseppina Vidili</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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