Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity
Identifieur interne : 001193 ( Pmc/Checkpoint ); précédent : 001192; suivant : 001194Hypofractionated 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.
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.
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DOI: 10.1186/s13014-015-0480-y
PubMed: 26289040
PubMed Central: 4554321
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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="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. 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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. 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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></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 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Radiat Oncol</journal-id><journal-id journal-id-type="iso-abbrev">Radiat Oncol</journal-id><journal-title-group><journal-title>Radiation Oncology (London, England)</journal-title></journal-title-group><issn pub-type="epub">1748-717X</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26289040</article-id><article-id pub-id-type="pmc">4554321</article-id><article-id pub-id-type="publisher-id">480</article-id><article-id pub-id-type="doi">10.1186/s13014-015-0480-y</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Guenzi</surname><given-names>Marina</given-names></name><address><email>marina.guenzi@hsanmartino.it</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Blandino</surname><given-names>Gladys</given-names></name><address><email>blandinog.81@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Vidili</surname><given-names>Maria Giuseppina</given-names></name><address><email>mariagiuseppina.vidili@hsanmartino.it</email></address><xref ref-type="aff" rid="Aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Aloi</surname><given-names>Deborah</given-names></name><address><email>aloideborah@yahoo.it</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Configliacco</surname><given-names>Elena</given-names></name><address><email>ele.confy@virgilio.it</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Verzanini</surname><given-names>Elisa</given-names></name><address><email>verzanini.elisa@libero.it</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Tornari</surname><given-names>Elena</given-names></name><address><email>ele.tornari@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Cavagnetto</surname><given-names>Francesca</given-names></name><address><email>Francesca.cavagnetto@hsanmartino.it</email></address><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Corvò</surname><given-names>Renzo</given-names></name><address><email>renzo.corvo@unige.it</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1"><label></label>Department of Radiotherapy – IRCCS A.O.U. San Martino – IST, Genoa, Italy</aff><aff id="Aff2"><label></label>Department of Medical Physics – IRCCS A.O.U. San Martino – IST, Genoa, Italy</aff><aff id="Aff3"><label></label>Department of Oncological Rehabilitation – IRCCS A.O.U. San Martino – IST, Genoa, Italy</aff></contrib-group><pub-date pub-type="epub"><day>20</day><month>8</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>20</day><month>8</month><year>2015</year></pub-date><pub-date pub-type="collection"><year>2015</year></pub-date><volume>10</volume><elocation-id>177</elocation-id><history><date date-type="received"><day>17</day><month>3</month><year>2015</year></date><date date-type="accepted"><day>7</day><month>8</month><year>2015</year></date></history><permissions><copyright-statement>© Guenzi et al. 2015</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold> This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><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></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Breast cancer</kwd><kwd>Hypofractionation</kwd><kwd>Regional Nodal Irradiation</kwd><kwd>Toxicity</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2015</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc><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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