Incidental axillary irradiation during three-dimensional conformal radiotherapy for breast cancer: which factors can influence this coverage?

ABSTRACT

Objective: To evaluate the percentage of I and II axillary levels receiving 45 Gy during adjuvant radiotherapy for breast cancer and correlate it with anatomical and planning variables. Methods: A retrospective study of 51 patients with breast cancer who received adjuvant external radiotherapy in breast or breast bed with tridimensional conformal technique during January 2008 to July 2013. Axillary levels were contoured according to the breast cancer atlas of Radiation Therapy Oncology Group (RTOG). The percentage of each axillary level that received 45 Gy (V45) was reviewed using the dose volume histogram (DVH). This was correlated with the surgery performed, the Clinical Target Volume (CTV), axillary volume, anteroposterior (APD) and laterolateral diameters (LLD) of chest, body mass index (BMI), gantry's angle, distance between the input and output (DIO) of the radiation beam in chest, and patient position (ramp incline, height and angle of the arm). Results: The average V45 for level I and II was 44% (0 to 97.2%) and 17.7% (0 to 93.6%). The average dose in 95% of level I was 11.2 Gy (0.14-46.4 Gy) and 5 Gy (0.13-44.4 Gy) in level II. Variables with significant correlation to V45 of level I were the ramp incline (p<0.001) and DIO (p<0.019) and the ramp incline with level II V45(p= 0.004) in multiple univariate analysis. Ramp incline, DIO and LLD correlate with V45 of level I in multivariate analysis (p= 0.012, p= 0.007, p= 0.012, respectively). Patients with BMI>25 received higher doses in level I (p=0.026). Conclusion: Axillary coverage with 45 Gy during adjuvant breast irradiation is not adequate but appear to increase with a larger ramp incline and bigger DIO. Dose in Level I increases whith BMI>25 although remains unsatisfactory.

RESUMO

Objetivo: Avaliar a porcentagem dos níveis axilares I e II que receberam 45 Gy durante a radioterapia adjuvante para câncer de mama e correlacioná-la com variáveis anatômicas e de planejamento. Métodos: Estudo retrospectivo de 51 pacientes com câncer de mama que receberam radioterapia externa adjuvante na mama ou leito mamário com técnica conformada tridimensional entre janeiro de 2008 e julho de 2013. Os níveis axilares foram contornados de acordo com o atlas de câncer de mama do Radiation Therapy Oncology Group (RTOG). A porcentagem de cada nível axilar que recebeu 45 Gy (V45) foi revisada usando o histograma dose-volume (DVH). Isso foi correlacionado com a cirurgia realizada, o volume clínico alvo (CTV), volume axilar, diâmetros anteroposterior (APD) e laterolateral (LLD) do tórax, índice de massa corporal (BMI), ângulo do pórtico, distância entre a entrada e a saída (DIO) do feixe de radiação no peito e posição do paciente (inclinação da rampa, altura e ângulo do braço). Resultados: O V45 médio para os níveis I e II foi de 44% (0 a 97,2%) e 17,7% (0 a 93,6%). A dose média em 95% do nível I foi de 11,2 Gy (0,14-46,4 Gy) e 5 Gy (0,13-44,4 Gy) no nível II. As variáveis com correlação significativa com o V45 do nível I foram a inclinação da rampa (p <0,001) e DIO (p <0,019) e a inclinação da rampa com o V45 do nível II (p = 0,004) na análise univariada múltipla. Inclinação da rampa, DIO e LLD correlacionam-se com o V45 do nível I na análise multivariada (p = 0,012, p = 0,007, p = 0,012, respectivamente). Pacientes com IMC> 25 receberam doses mais elevadas no nível I (p = 0,026). Conclusão: A cobertura axilar com 45 Gy durante a irradiação adjuvante da mama não é adequada, mas parece aumentar com uma maior inclinação da rampa e maior DIO. A dose no nível I aumenta com IMC> 25, embora permaneça insatisfatória.

Headings:

Radiotherapy - Lymphatic irradiation - Breast neoplasms - Radiotherapy dosage

Descritores:

Radioterapia - Irradiação linfática - Neoplasias da mama - Dosagem de radioterapia

AUTHOR'S CONTRIBUTION

Lícia Moreira Medeiros Araújo: Collection and assembly of data, Data analysis and interpretation, Manuscript writing.

Vinicius Fernandes Araújo: Collection and assembly of data.

Rodrigo Souza Dias: Collection and assembly of data, Conception and design, Final approval of manuscript.

Adelmo José Giordani: Conception and design, Provision of study materials or patient.

Roberto Araújo Segreto: Conception and design, Final approval of manuscript.

Helena Regina Comodo Segreto: Conception and design, Data analysis and interpretation, Final approval of manuscript, Manuscript writing.

Publication History

Received: 25 August 2018

Accepted: 28 February 2020

Article published online:
02 July 2020

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