International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: breastEvaluation of level I and II axillary nodes included in the standard breast tangential fields and calculation of the administered dose: results of a prospective study
Introduction
After conservative surgery, the breast is usually irradiated with two tangential fields. Although it is generally believed that the lower portion of the axilla is adequately treated with the same fields used for the breast 1, 2, only a few studies have been conducted to ascertain if this assumption is valid 3, 4, 5.
We carried out a prospective study to evaluate if the standard breast tangential fields include the first two axillary node levels. Furthermore, we calculated the dose administered to these nodes and the dose to 90% of both volumes.
Section snippets
Methods and materials
Thirty-five patients treated with conservative surgery and axillary dissection for early-stage breast cancer were enrolled. Three clips were positioned during surgery; the patient lay supine with the ipsilateral arm extended laterally at 90° respective to the trunk. The first and second clips were put on the internal and external borders of the pectoralis minor muscle; the third was positioned at the lowest point of surgical dissection (Fig. 1). According to this clip placement, Level I begins
Results
On simulation films, the volume between the clips corresponding to Level I was completely included in the medial field in 66.7% of cases and in the lateral field in 63.7% of cases; the volume of Level II was entirely included in the medial field in 54.5% of cases and in the lateral field in 45.4% of cases. None of the parameters taken into account with the Pearson test (field length, gantry angle, and collimator angle) were significantly correlated with the percentage of clips defining the
Discussion
Although it is commonly assumed that nodes of axillary Levels I and II are included in the standard breast tangential fields, only a few studies have been conducted to ascertain if this assumption is valid 3, 4, 5. In two of these studies, the evaluation was retrospective 3, 4. Simulator films were reviewed, and the clips, placed to obtain hemostasis in the axilla at the time of axillary dissection, were considered surrogate locations for the axillary nodes. Results from both studies showed
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