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    Analysis of axillary coverage during tangential radiation therapy to the breast

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    Authors
    Reznik, Julia
    Cicchetti, Maria Giulia
    Degaspe, Barbara
    Fitzgerald, Thomas J.
    Faculty Advisor
    Thomas J. Fitzgerald
    UMass Chan Affiliations
    Department of Radiation Oncology
    Document Type
    Journal Article
    Publication Date
    2005-01-01
    Keywords
    Adult
    Aged
    Axilla
    Breast Neoplasms
    Female
    Humans
    Lymphatic Irradiation
    Middle Aged
    Radiotherapy Dosage
    Radiotherapy Planning, Computer-Assisted
    Retrospective Studies
    Neoplasms
    Oncology
    Radiology
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    Link to Full Text
    http://dx.doi.org/10.1016/j.ijrobp.2004.04.065
    Abstract
    PURPOSE: To evaluate the percent of the prescribed radiation dose to the breast delivered to the axillary tissue and to evaluate the volume of the axilla receiving 95% of the prescribed dose with normal and with high tangential fields. METHODS AND MATERIALS: Computed tomographic scan images with 5-mm sections were retrospectively analyzed for 35 patients who had undergone three-dimensional (3D) planning for whole-breast radiation. The axillary nodal region was identified and divided into Levels I to III and Rotter's nodes (RN). Digitally reconstructed radiographs were created, and two plans were developed: (a) the standard clinical opposed tangential irradiation fields and (b) the high-tangential irradiation fields. Axillary coverage was examined by use of dose-volume histograms (DVH), and the average coverage for the four nodal groups was obtained. RESULTS: The data show that with the standard tangential irradiation fields, the average dose delivered to Levels I, II, III, and RN is 66% (standard deviation, or SD = 13%), 44% (SD = 18%), 31% (SD = 20%), and 70% (SD = 19%) of the prescribed dose, respectively. The coverage increases to 86% (SD = 9%), 71% (SD = 19%), 73% (SD = 17%), and 94% (SD = 8%) of the prescribed dose, respectively, for Levels I, II, III, and RN when the high tangential irradiation fields are used. 51% of Level I, 26% of Level II, and 15% of Level III receive 95% of the prescribed dose with normal tangents. The volume increases to 79%, 51%, and 49% of Levels I, II, and III, respectively, with high tangents. CONCLUSION: The tangential fields designed to treat only the breast do not adequately cover the axillary region and, therefore, cannot be relied upon for prophylactic therapy of the axilla. The high tangential irradiation fields increase the dosages received by the axillary region, but the average dosages received by the lower axillary regions are still less than 90% of the prescribed dose.
    Source
    Int J Radiat Oncol Biol Phys. 2005 Jan 1;61(1):163-8. Link to article on publisher's site
    DOI
    10.1016/j.ijrobp.2004.04.065
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49232
    PubMed ID
    15629607
    Notes

    Medical student Julia Reznik participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.

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    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ijrobp.2004.04.065
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