Internal Mammary Node Evaluation And Elective Nodal Treatment In Medial Breast Cancers: A Case Report And Review Of The Literature.

E. Miles, C. Cinnamond, C. Allgeier, J. Nelson
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Abstract

The evaluation and treatment of the internal mammary nodes (IMNs) in patients with axillary node positive breast cancer undergoing breast conservation therapy is somewhat controversial. A recently reported randomized trial of radiation therapy to the local regional nodes (including the IMNs) in patients undergoing breast conservation therapy demonstrated an improvement in disease free survival and overall survival with this additional nodal irradiation. For patients with tumors in the medial quadrants of the breast, consideration of peritumoral sentinel lymph node procedures with or without periareolar injections should be considered as demonstrated lymphatic drainage to the IMNs may indicate a greater need to consider their inclusion in adjuvant radiation therapy fields, regardless of clinical or radiographic involvement. These nodes may be treated either with a separate IMN field or partially-wide tangents. The benefits of this inclusion must be weighed against the risks of side effects of increased radiation exposure of lung, heart and contralateral breast tissue. Additional long-term data from randomized trials currently underway and maturing may help to define the risks versus the benefits of IMN elective nodal irradiation
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内侧乳腺癌乳腺内淋巴结评估及选择性淋巴结治疗:1例报告及文献复习。
腋淋巴结阳性乳腺癌患者行保乳治疗后,其内乳淋巴结(IMNs)的评估和治疗存在一定的争议。最近报道的一项随机试验表明,在接受乳房保护治疗的患者中,局部区域淋巴结(包括imn)的放射治疗表明,这种额外的淋巴结照射可以改善无病生存和总生存。对于乳腺内象限的肿瘤患者,考虑采用或不采用乳晕周围注射的肿瘤周围前哨淋巴结手术,因为已证实的淋巴引流到imn可能表明更需要考虑将其纳入辅助放射治疗领域,无论临床或影像学是否涉及。这些节点可以用单独的IMN域或部分宽切线处理。这种纳入的好处必须与肺、心脏和对侧乳房组织辐射暴露增加的副作用风险进行权衡。来自目前正在进行和成熟的随机试验的额外长期数据可能有助于确定IMN选择性淋巴结照射的风险与收益
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