Radiotherapy of MRI-detected involved internal mammary lymph nodes in breast cancer.
Radiotherapy of MRI-detected involved internal mammary lymph nodes in breast cancer.
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DOI：
10.1186/s13014-017-0934-5
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发表时间：
2017-12-19
期刊：
影响因子：
--
通讯作者：
Strauss JB
中科院分区：
文献类型：
--
作者：
Sachdev S;Goodman CR;Neuschler E;Kalakota K;Cutright D;Donnelly ED;Hayes JP;Prescott AE;Mirabelli G;Strauss JB
内乳（IM）淋巴结链，沿着腋窝淋巴结盆，是第一梯队的乳房淋巴引流部位。越来越多的证据支持在淋巴结阳性乳腺癌中照射该区域。本研究评价了放射治疗在治疗新诊断的非转移性乳腺癌中磁共振成像（MRI）检测到的异常IM淋巴结中的有效性。对电子机构数据库进行结构化查询，以识别2005年至2013年乳腺MRI上有异常IM淋巴结放射学证据的女性。根据病理大小标准和/或异常增强，手动审查将入选范围缩小至主要诊断为非转移性乳腺癌伴异常IM淋巴结的患者。在接受治疗前MRI的7070名女性中，19名（0.3%）在成像中被确定为共有25个异常治疗前IM淋巴结，其中96%位于前两个肋间隙，4%位于第三间隙。大多数原发性肿瘤为高级别（94.7%）和HER-2/neu受体阴性（73.7%），而47.4%过表达HER-2/neu受体。89.5%的患者存在腋窝淋巴结疾病，而1例患者有锁骨上受累。在中位随访38个月时，31.6%的患者发生转移性疾病，21.1%的患者死于疾病。在接受IM覆盖的患者中，IM淋巴结链内无疾病进展。治疗前IM链淋巴结异常的放射学证据与晚期、高级别和雌激素受体阴性状态相关。大多数阳性淋巴结位于前两个肋间隙内，而没有位于第三个肋间隙以下。IM链放疗联合现代全身治疗在该队列患者中可有效实现局部控制而无需手术切除。
The internal mammary (IM) lymph node chain, along with the axillary nodal basin, is a first-echelon breast lymphatic draining site. A growing body of evidence supports irradiation of this region in node-positive breast cancer. This study evaluated the effectiveness of radiotherapy in treating magnetic resonance imaging (MRI)-detected abnormal IM lymph nodes in newly-diagnosed non-metastatic breast cancer. A structured query was performed on an electronic institutional database to identify women with radiographic evidence of abnormal IM node(s) on breast MRI from 2005 to 2013. Manual review narrowed inclusion to patients with a primary diagnosis of non-metastatic breast cancer with abnormal IM node(s) based on pathologic size criteria and/or abnormal enhancement. Of the 7070 women who underwent pre-treatment MRI, 19 (0.3%) were identified on imaging to have a total of 25 abnormal pre-treatment IM lymph nodes, of which 96% were located in the first two intercostal spaces and 4% in the third space. A majority of the primary tumors were high-grade (94.7%) and hormone-receptor negative (73.7%), while 47.4% overexpressed HER-2/neu receptor. Axillary nodal disease was present in 89.5% of patients, while one patient had supraclavicular involvement. At a median follow-up of 38 months, 31.6% of patients had developed metastatic disease and 21.1% had died from their disease. Of the patients who received IM coverage, none had progressive disease within the IM lymph node chain. Radiologic evidence of pre-treatment abnormal IM chain lymph nodes was associated with advanced stage, high grade, and negative estrogen receptor status. The majority of positive lymph nodes were located within the first two intercostal spaces, while none were below the third. Radiation of the IM chain in combination with modern systemic therapy was effective in achieving locoregional control without surgical resection in this cohort of patients.
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影响因子：
168.9
作者：
Overgaard, M;Jensen, MB;Mouridsen, HT
通讯作者：
Mouridsen, HT
影响因子：
45.3
作者：
Thorsen, Lise Bech Jellesmark;Offersen, Birgitte Vrou;Overgaard, Jens
通讯作者：
Overgaard, Jens
影响因子：
158.5
作者：
Poortmans, P. M.;Collette, S.;van den Bogaert, W.
通讯作者：
van den Bogaert, W.
影响因子：
10.3
作者：
Ragaz, J;Olivotto, IA;Manji, M
通讯作者：
Manji, M
DOI：
10.1016/j.ijrobp.2013.02.037
发表时间：
2013-08-01
影响因子：
7
作者：
Chang, Jee Suk;Park, Won;Huh, Seung Jae
通讯作者：
Huh, Seung Jae