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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Caught in the middle: case study of a brachial (sentry) lymph node recurrence after resection and locoregional breast radiotherapy</title>
<author><name sortKey="Lee, G" sort="Lee, G" uniqKey="Lee G" first="G." last="Lee">G. Lee</name>
<affiliation><nlm:aff id="af1-conc-19-e211">Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Clemons, M" sort="Clemons, M" uniqKey="Clemons M" first="M." last="Clemons">M. Clemons</name>
<affiliation><nlm:aff id="af2-conc-19-e211">Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cho, J" sort="Cho, J" uniqKey="Cho J" first="J." last="Cho">J. Cho</name>
<affiliation><nlm:aff id="af1-conc-19-e211">Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af2-conc-19-e211">Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af3-conc-19-e211">Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Czarnota, G J" sort="Czarnota, G J" uniqKey="Czarnota G" first="G. J." last="Czarnota">G. J. Czarnota</name>
<affiliation><nlm:aff id="af4-conc-19-e211">Department of Radiation Oncology and Imaging Research, Sunnybrook Health Sciences Centre, Toronto, ON</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Dinniwell, R" sort="Dinniwell, R" uniqKey="Dinniwell R" first="R." last="Dinniwell">R. Dinniwell</name>
<affiliation><nlm:aff id="af1-conc-19-e211">Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af2-conc-19-e211">Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af3-conc-19-e211">Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">22670111</idno>
<idno type="pmc">3364782</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364782</idno>
<idno type="RBID">PMC:3364782</idno>
<idno type="doi">10.3747/co.19.934</idno>
<date when="2012">2012</date>
<idno type="wicri:Area/Pmc/Corpus">002D66</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002D66</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Caught in the middle: case study of a brachial (sentry) lymph node recurrence after resection and locoregional breast radiotherapy</title>
<author><name sortKey="Lee, G" sort="Lee, G" uniqKey="Lee G" first="G." last="Lee">G. Lee</name>
<affiliation><nlm:aff id="af1-conc-19-e211">Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Clemons, M" sort="Clemons, M" uniqKey="Clemons M" first="M." last="Clemons">M. Clemons</name>
<affiliation><nlm:aff id="af2-conc-19-e211">Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cho, J" sort="Cho, J" uniqKey="Cho J" first="J." last="Cho">J. Cho</name>
<affiliation><nlm:aff id="af1-conc-19-e211">Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af2-conc-19-e211">Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af3-conc-19-e211">Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Czarnota, G J" sort="Czarnota, G J" uniqKey="Czarnota G" first="G. J." last="Czarnota">G. J. Czarnota</name>
<affiliation><nlm:aff id="af4-conc-19-e211">Department of Radiation Oncology and Imaging Research, Sunnybrook Health Sciences Centre, Toronto, ON</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Dinniwell, R" sort="Dinniwell, R" uniqKey="Dinniwell R" first="R." last="Dinniwell">R. Dinniwell</name>
<affiliation><nlm:aff id="af1-conc-19-e211">Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af2-conc-19-e211">Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af3-conc-19-e211">Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Current Oncology</title>
<idno type="ISSN">1198-0052</idno>
<idno type="eISSN">1718-7729</idno>
<imprint><date when="2012">2012</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><p>To reduce local recurrence, adjuvant locoregional radiotherapy is given routinely for post-mastectomy breast patients with 4 or more positive lymph nodes. Most institutions adopt a 3- or 4-field radiotherapy technique, in which the field and shielding placements are informed by bony anatomic landmarks viewed on digitally reconstructed radiographs.</p>
<p>Here, we report on a 40-year-old woman who underwent a lumpectomy with axillary node dissection, followed by chemotherapy, completion mastectomy, and adjuvant locoregional radiotherapy (50 Gy in 25 fractions) for a multicentric pT1cN2aM0 invasive ductal carcinoma of the right breast. At 9 months after radiotherapy, she presented with a palpable brachial lymph node, a major draining node of the upper extremity, in the axilla, abutting the previous anterior supraclavicular and axillary radiation fields. This occurrence highlights the potential superolateral border of the level <sc>i</sc>
axillary nodal chain and its relationship to the upper extremity lymphatics via the brachial (“sentry”) node. Adapting the delineated nodal target volume in locoregional radiotherapy of the breast for disease with extensive nodal involvement or other high-risk pathologic indications may be warranted in certain situations. Careful imaging and an informed discussion with the patient is needed before deciding to treat the sentry node and including the acromial–clavicular joints, balanced with the potential increased risk of lymphedema.</p>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Curr Oncol</journal-id>
<journal-id journal-id-type="iso-abbrev">Curr Oncol</journal-id>
<journal-id journal-id-type="publisher-id">CO</journal-id>
<journal-title-group><journal-title>Current Oncology</journal-title>
</journal-title-group>
<issn pub-type="ppub">1198-0052</issn>
<issn pub-type="epub">1718-7729</issn>
<publisher><publisher-name>Multimed Inc.</publisher-name>
<publisher-loc>66 Martin St. Milton, ON, Canada L9T 2R2</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">22670111</article-id>
<article-id pub-id-type="pmc">3364782</article-id>
<article-id pub-id-type="doi">10.3747/co.19.934</article-id>
<article-id pub-id-type="publisher-id">conc-19-e211</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Radiation Oncology</subject>
</subj-group>
</article-categories>
<title-group><article-title>Caught in the middle: case study of a brachial (sentry) lymph node recurrence after resection and locoregional breast radiotherapy</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Lee</surname>
<given-names>G.</given-names>
</name>
<degrees>BSc CMD</degrees>
<xref ref-type="aff" rid="af1-conc-19-e211"><sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Clemons</surname>
<given-names>M.</given-names>
</name>
<degrees>MB BS MD</degrees>
<xref ref-type="aff" rid="af2-conc-19-e211"><sup>†</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cho</surname>
<given-names>J.</given-names>
</name>
<degrees>MD PhD</degrees>
<xref ref-type="aff" rid="af1-conc-19-e211"><sup>*</sup>
</xref>
<xref ref-type="aff" rid="af2-conc-19-e211"><sup>†</sup>
</xref>
<xref ref-type="aff" rid="af3-conc-19-e211"><sup>‡</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Czarnota</surname>
<given-names>G.J.</given-names>
</name>
<degrees>PhD MD</degrees>
<xref ref-type="aff" rid="af4-conc-19-e211"><sup>§</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dinniwell</surname>
<given-names>R.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="corresp" rid="c1-conc-19-e211"></xref>
<xref ref-type="aff" rid="af1-conc-19-e211"><sup>*</sup>
</xref>
<xref ref-type="aff" rid="af2-conc-19-e211"><sup>†</sup>
</xref>
<xref ref-type="aff" rid="af3-conc-19-e211"><sup>‡</sup>
</xref>
</contrib>
</contrib-group>
<aff id="af1-conc-19-e211"><label>*</label>
Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON</aff>
<aff id="af2-conc-19-e211"><label>†</label>
Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON</aff>
<aff id="af3-conc-19-e211"><label>‡</label>
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON</aff>
<aff id="af4-conc-19-e211"><label>§</label>
Department of Radiation Oncology and Imaging Research, Sunnybrook Health Sciences Centre, Toronto, ON</aff>
<author-notes><corresp id="c1-conc-19-e211">Correspondence to: Rob Dinniwell, Department of Radiation Oncology, Princess Margaret Hospital, 5th floor, 610 University Avenue, Toronto, Ontario M5G 2M9. E-mail: <email>Rob.Dinniwell@rmp.uhn.on.ca</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>6</month>
<year>2012</year>
</pub-date>
<volume>19</volume>
<issue>3</issue>
<fpage>e211</fpage>
<lpage>e215</lpage>
<permissions><copyright-statement>2012 Multimed Inc.</copyright-statement>
<copyright-year>2012</copyright-year>
</permissions>
<abstract><p>To reduce local recurrence, adjuvant locoregional radiotherapy is given routinely for post-mastectomy breast patients with 4 or more positive lymph nodes. Most institutions adopt a 3- or 4-field radiotherapy technique, in which the field and shielding placements are informed by bony anatomic landmarks viewed on digitally reconstructed radiographs.</p>
<p>Here, we report on a 40-year-old woman who underwent a lumpectomy with axillary node dissection, followed by chemotherapy, completion mastectomy, and adjuvant locoregional radiotherapy (50 Gy in 25 fractions) for a multicentric pT1cN2aM0 invasive ductal carcinoma of the right breast. At 9 months after radiotherapy, she presented with a palpable brachial lymph node, a major draining node of the upper extremity, in the axilla, abutting the previous anterior supraclavicular and axillary radiation fields. This occurrence highlights the potential superolateral border of the level <sc>i</sc>
axillary nodal chain and its relationship to the upper extremity lymphatics via the brachial (“sentry”) node. Adapting the delineated nodal target volume in locoregional radiotherapy of the breast for disease with extensive nodal involvement or other high-risk pathologic indications may be warranted in certain situations. Careful imaging and an informed discussion with the patient is needed before deciding to treat the sentry node and including the acromial–clavicular joints, balanced with the potential increased risk of lymphedema.</p>
</abstract>
<kwd-group><kwd>Breast cancer</kwd>
<kwd>lymph node</kwd>
<kwd>regional recurrence</kwd>
<kwd>radiation field</kwd>
<kwd>regional radiotherapy</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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