Journal article
Evaluation of apical clips placed during axillary dissection demonstrates potential under‐coverage of axillary radiation therapy target volumes during breast cancer regional nodal irradiation
Journal of Medical Imaging and Radiation Oncology, Vol.66(1), pp.158-164
02/2022
PMID: 34821471
Metrics
23 Record Views
UN Sustainable Development Goals (SDGs)
This output has contributed to the advancement of the following goals:
Source: InCites
Abstract
Introduction: Evidence-based Australian guidelines (eviQ) recommend adjuvant supraclavicular fossa irradiation after axillary lymph node dissection (ALND) in node-positive breast cancer patients. Disparity between surgically determined versus computed tomography (CT) determined nodal volumes may result in discontiguous nodal volumes and untreated nodal tissue. We examine the extent of untreated nodal tissue in women with breast cancer post-level II or III ALND and adjuvant radiation therapy (RT) using ESTRO contouring guidelines.
Methods: Female breast cancer patients who underwent level II and III ALND with apical clip placement from 2016 to 2020 and CT simulated in supine position were included. CT-defined axillary level II-IV volumes were contoured using ESTRO guidelines. The distance between the apical clip and RT nodal volumes was measured to indicate extent of untreated tissue.
Results: Of 34 eligible patients treated by 7 surgeons, 76% had level II ALND and 24% level III ALND. Only 5.9% of clips entirely encompassed the corresponding RT nodal volumes. 55.9% of clips fell within and 44.1% fell inferolaterally outside the corresponding RT nodal volumes. A median 3.6 cm (range 0–7.5 cm) of undissected nodal tissue would not be included within standard RT target volumes following eviQ recommendations.
Conclusion: There is a disparity between surgically determined versus CT determined axillary nodal volumes, leading to discontiguous nodal volumes and untreated axillary nodal tissue, despite following standard radiation contouring guidelines. Intraoperatively placed apical axillary clips may assist radiation oncologists to accurately delineate undissected nodal tissues at risk.
Details
- Title
- Evaluation of apical clips placed during axillary dissection demonstrates potential under‐coverage of axillary radiation therapy target volumes during breast cancer regional nodal irradiation
- Creators
- Michael Ti Hsieh - Mid North Coast Cancer Institute, Coffs HarbourNoel J Aherne - Mid North Coast Cancer Institute, Coffs HarbourWilliam Ross - University of New South WalesShehnarz Salindera - Coffs Harbour Health CampusJustin Westhuyzen - Mid North Coast Cancer Institute, Coffs HarbourLauren Winkley - Mid North Coast Cancer Institute, Coffs HarbourThomas P Shakespeare - Mid North Coast Cancer Institute, Coffs Harbour
- Publication Details
- Journal of Medical Imaging and Radiation Oncology, Vol.66(1), pp.158-164
- Publisher
- Wiley-Blackwell Publishing Asia
- Identifiers
- 991012982980702368
- Copyright
- © 2021 Royal Australian and New Zealand College of Radiologists.
- Academic Unit
- School of Health and Human Sciences; Coffs Harbour Campus Administration; Faculty of Health
- Language
- English
- Resource Type
- Journal article