BACKGROUND AND PURPOSE: As the location of the regional lymph nodes (LNs) of the breast varies largely between patients and may be dependant on the position of the arm, adequate localization of these nodes is mandatory in order to fully take advantage of optimized conformal radiotherapy. For this purpose, the anatomical boundaries of the regional lymph node (LN) clinical target volumes (CTVs) for delineation on transverse CT-slices, made in treatment position, were established. PATIENTS AND METHODS: Anatomical and surgical descriptions of the regional LNs of the breast, as well as a shoulder dissection, were studied. Axial slices of a human cadaver with one arm in abduction and the other in adduction were investigated, to assess the displacement of LNs by abduction of the arm into treatment position. Based on these findings, we defined the anatomical boundaries of the regional LN CTVs visible on transverse CT-slices. RESULTS: Standard anatomical and surgical descriptions appeared to be inadequate for determination of the boundaries of the regional LN CTVs in treatment position. With abduction of the arm, a change in position of all regional LNs, except for the medial supraclavicular LNs and internal mammary LNs, was observed in the anatomical cross-sections. This was also taken into account in our delineation protocol proposal. CONCLUSIONS: Anatomically based guidelines for delineation of the regional LN CTVs for loco-regional irradiation of the breast on transverse CT-slices, made in treatment position, have been developed in this study. These could be used as a basis for conformal radiotherapy.
BACKGROUND AND PURPOSE: As the location of the regional lymph nodes (LNs) of the breast varies largely between patients and may be dependant on the position of the arm, adequate localization of these nodes is mandatory in order to fully take advantage of optimized conformal radiotherapy. For this purpose, the anatomical boundaries of the regional lymph node (LN) clinical target volumes (CTVs) for delineation on transverse CT-slices, made in treatment position, were established. PATIENTS AND METHODS: Anatomical and surgical descriptions of the regional LNs of the breast, as well as a shoulder dissection, were studied. Axial slices of a human cadaver with one arm in abduction and the other in adduction were investigated, to assess the displacement of LNs by abduction of the arm into treatment position. Based on these findings, we defined the anatomical boundaries of the regional LN CTVs visible on transverse CT-slices. RESULTS: Standard anatomical and surgical descriptions appeared to be inadequate for determination of the boundaries of the regional LN CTVs in treatment position. With abduction of the arm, a change in position of all regional LNs, except for the medial supraclavicular LNs and internal mammary LNs, was observed in the anatomical cross-sections. This was also taken into account in our delineation protocol proposal. CONCLUSIONS: Anatomically based guidelines for delineation of the regional LN CTVs for loco-regional irradiation of the breast on transverse CT-slices, made in treatment position, have been developed in this study. These could be used as a basis for conformal radiotherapy.
Authors: Alice Y Ho; Ase Ballangrud; Guang Li; Gaorav P Gupta; Beryl McCormick; Richard Gewanter; Daphna Gelblum; Melissa Zinovoy; Boris Mueller; Borys Mychalczak; Pinaki Dutta; Karen Borofsky; Preeti Parhar; Marsha Reyngold; Lior Z Braunstein; Mohit Chawla; Kate Krause; Natasha Freeman; Chun Ting Siu; Zachary Cost; Brittany B Arnold; Zhigang Zhang; Simon N Powell Journal: Int J Radiat Oncol Biol Phys Date: 2018-11-30 Impact factor: 7.038
Authors: Y M Kirova; P Castro Pena; R Dendale; V Servois; M A Bollet; N Fournier-Bidoz; F Campana; A Fourquet Journal: Br J Radiol Date: 2009-12-17 Impact factor: 3.039
Authors: M-L Sautter-Bihl; F Sedlmayer; W Budach; J Dunst; P Feyer; R Fietkau; C Fussl; W Haase; W Harms; M D Piroth; R Souchon; F Wenz; R Sauer Journal: Strahlenther Onkol Date: 2014-03-05 Impact factor: 3.621
Authors: Tristan C F van Heijst; Bram van Asselen; Ruud M Pijnappel; Marissa Cloos-van Balen; Jan J W Lagendijk; Desirée van den Bongard; Mariëlle E P Philippens Journal: Br J Radiol Date: 2016-05-10 Impact factor: 3.039
Authors: Laura Cella; Raffaele Liuzzi; Mario Magliulo; Manuel Conson; Luigi Camera; Marco Salvatore; Roberto Pacelli Journal: Radiat Oncol Date: 2010-05-11 Impact factor: 3.481
Authors: Valerie K Reed; Jose L Cavalcanti; Eric A Strom; George H Perkins; Julia L Oh; Welela Tereffe; Tse-Kuan Yu; Henry Yeung; Gary J Whitman; Isabelle Bedrosian; Homer A Macapinlac; Thomas A Buchholz; Wendy A Woodward Journal: Int J Radiat Oncol Biol Phys Date: 2007-12-31 Impact factor: 7.038