Axillary coverage by whole breast irradiation in 1 to 2 positive sentinel lymph nodes in breast cancer patients



To evaluate the dosimetric coverage of axillary levels I, II, and III obtained with standard whole breast irradiation in 1 to 2 positive sentinel lymph nodes (SLNs) patients not submitted to axillary lymph nodes dissection (ALND), and to compare the lymph nodes areas coverage obtained with 3D conformal radiation therapy, intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT).


Patients with 1 to 2 positive SLNs undergoing breast-conserving therapy, without ALND, were included in the analysis. For each patient, 3 treatment plans were performed: a 3D conventional tangential plan, a static IMRT plan, and a volumetric IMRT, designed to encompass the entire breast parenchyma. The volumes of axillary levels I, II, and III receiving 90% and 95% (V90, V95) of the whole breast prescribed dose were evaluated. Dose-volume histograms were compared by means of the Friedman test.


Ten patients were enrolled. All defined breast volumes received >95% of the prescribed dose with the 3 techniques. Median V95 for axillary level I was 26.4% (range 4.7%-61.3%) for 3D plans, 8.6% (range 0.64%-19.1%) for static IMRT plans, and 2.6% (range 0.4%-4.7%) for volumetric IMRT plans (p<0.001). Median V95 for axillary level II was 5.4% (range 0%-14.6%), 1.9% (range 0%-15%), and 2.6% (range 0.4%-4.7%) for 3D, static IMRT, and volumetric IMRT, respectively (p<0.001).


Results of our analysis showed that standard 3D tangential whole breast irradiation failed to deliver a therapeutic dose to axillary levels I and II. The coverage was even lower using static and volumetric IMRT techniques.

Tumori 2016; 102(4): 409 - 413




Maria Carmen De Santis, Francesca Bonfantini, Michela Dispinzieri, Silvia Meroni, Barbara Diletto, Elisa D. Mantero, Marzia Franceschini, Fulvia Soncini, Serena Di Cosimo, Vito Cosentino, Emanuele Pignoli, Laura Lozza

Article History


Financial support: No financial support was received for this submission.
Conflict of interest: None of the authors has conflict of interest with this submission.

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  • Radiotherapy Unit 1, National Cancer Institute of Milan, Milan - Italy
  • Medical Physics Unit, National Cancer Institute of Milan, Milan - Italy
  • Oncology Department, National Cancer Institute of Milan, Milan - Italy

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