• Investigative Magnetic Resonance Imaging
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• v.22 no.4
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• pp.245-248
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• 2018

Foreign body injections into breasts may produce foreign body reactions, fibrosis, and local swelling of involved lymph nodes, which can be misdiagnosed as metastasis or malignancy. Here, the authors report MR imaging, PET-CT imaging, and pathologic findings of contralateral internal mammary lymphadenopathy suspicious of breast cancer metastasis in a 58-year-old woman with history of left breast cancer, and previous interstitial mammoplasty by paraffin injection in both breasts.

• Archives of Plastic Surgery
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• v.42 no.4
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• pp.497-499
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• 2015

• Radiation Oncology Journal
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• v.25 no.4
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• pp.261-267
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• 2007

Purpose: To evaluate the association between radiation pneumonitis and dose-volume histogram parameters and to provide practical guidelines to prevent radiation pneumonitis following radiotherapy administered for breast cancer including internal mammary lymph nodes. Materials and Methods: Twenty patients with early breast cancer who underwent a partial mastectomy were involved in this study. The entire breast, supraclavicular lymph nodes, and internal mammary lymph nodes were irradiated with a dose of 50.4 Gy in 28 fractions. Radiation pneumonitis was assessed by both radiological pulmonary change (RPC) and by evaluation of symptomatic radiation pneumonitis. Dose-volume histogram parameters were compared between patients with grade <2 RPC and those with grade ${\geq}$2 RPC. The parameters were the mean lung dose, V10 (percent lung volume receiving equal to and more than 10 Gy), V20, V30, V40, and normal tissue complication probability (NTCP). Results: Of the 20 patients, 9 (45%) developed grade 2 RPC and 11 (55%) did not develop RPC (grade 0). Only one patient developed grade 1 symptomatic radiation pneumonitis. Univariate analysis showed that among the dose-volume histogram parameters, NTCP was significantly different between the two RPC grade groups (p<0.05). Fisher's exact test indicated that an NTCP value of 45% was appropriate as an RPC threshold level. Conclusion: This study shows that NTCP can be used as a predictor of RPC after radiotherapy of the internal mammary lymph nodes in breast cancer. Clinically, it indicates that an RPC is likely to develop when the NTCP is greater than 45%.

• Radiation Oncology Journal
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• v.37 no.2
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• pp.91-100
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• 2019

Purpose: Internal mammary lymph node (IMN) involvement is associated with poor prognosis in breast cancer. This study investigated the treatment outcomes of initial clinically IMN-positive breast cancer patients who received adjuvant radiotherapy (RT), including IMN irradiation, following primary breast surgery. Materials and Methods: We retrospectively reviewed data of 95 breast cancer patients with clinically detected IMNs at diagnosis treated with surgery and RT between June 2009 and December 2015. Patients received adjuvant RT to the whole breast/chest wall and regional lymph node (axillary, internal mammary, and supraclavicular) areas. Twelve patients received an additional boost to the IMN area. Results: The median follow-up was 43.2 months (range, 4.5 to 100.5 months). Among 77 patients who received neoadjuvant chemotherapy, 52 (67.5%) showed IMN normalization and 19 (24.6%) showed a partial response to IMN. There were 3 and 24 cases of IMN failure and any recurrence, respectively. The 5-year IMN failure-free survival, disease-free survival (DFS), and overall survival (OS) were 96%, 70%, and 84%, respectively. IMN failure-free survival was significantly affected by resection margin status (97.7% if negative, 87.5% for close or positive margins; p = 0.009). All three patients with IMN failure had initial IMN size ≥1 cm and did not receive IMN boost irradiation. The median age of the three patients was 31 years, and all had hormone receptor-negative tumors. Conclusion: RT provides excellent IMN control without the support of IMN surgery. Intensity-modulated radiotherapy, including IMN boost for breast cancer patients, is a safe and effective technique for regional lymph node irradiation.

• Radiation Oncology Journal
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• v.27 no.1
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• pp.35-41
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• 2009

Purpose: This study was designed to determine the optimum radiotherapy technique for internal mammary node (IMN) irradiation after breast-conserving surgery. Materials and Methods: We selected ten cases of early stage partial mastectomy for plan comparison. Five of the patients were treated to the right-side breast and the rest of the patients were treated to the left-side breast. For each case, four different treatment plans were made to irradiate the entire breast, IMNs and supraclavicular lymph nodes (SCLs). The four planning techniques include a standard tangential field (STF), wide tangential field (WTF), partially wide tangential field (PWT) and a photon-electron mixed field (PEM). We prescribed a dose of 50.4 Gy to the SCL field at a 3 cm depth and isocenter of the breast field. Results: The dose distribution showed clear characteristics depending on the technique used. All of the techniques covered the breast tissue well. IMN coverage was also good, except for the STF, which was not intended to cover IMNs. For the cases of the left-side breasts, the volume of the heart that received more than 30 Gy was larger (in order) for the WTF, PWT, PEM and STF. For radiation pneumonitis normal tissue complication probability (NTCP), the PWT showed the best results followed by the STF. Conclusion: Despite the variety of patient body shapes, the PWT technique showed the best results for coverage of IMNs and for reducing the lung and heart dose.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.27-35
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• 2017

Purpose: On the left side, breast cancer patients have more side effects than those on the right side because of unnecessary doses in normal organs such as heart and lung. DIBH is performed to reduce this. To evaluate the dose of peripheral organs in the left breast cancer including supraclavicular lymph nodes and internal mammary lymph nodes according to the treatment planning method of Conventional Radiation Therapy, Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy. Materials and Methods: We performed CT-simulation using free breathing and deep inspiration breath-hold technique for 8 patients including left supraclavicular lymph nodes and internal mammary lymph nodes. Based on the acquired CT images, the contour of the body is drawn and the convention is performed so that $95%{\leftarrow}PTV$, $Dmax{\leftarrow}110%$. Conventional Radiation Therapy used a one portal technique on the supraclavicular lymph node and used a field in field technique tangential beam on the breast. Intensity Modulated Radiation Therapy was composed of 7 static fields. Volumetric Modulated Arc Therapy was planned using 2 ARC with a turning radius of $290^{\circ}$ to $179^{\circ}$. The peripheral normal organs dose was analyzed by referring to the dose volume of Eclipse. Results: By applying the deep inspiration breath-hold technique, the mean interval between the heart and chest wall increased $1.6{\pm}0.6cm$. The mean dose of lung was $19.2{\pm}1.0Gy$, which was the smallest value in Intensity Modulated Radiation Therapy. The V30 (%) of the heart was $2.0{\pm}1.9$, which was the smallest value in Intensity Modulated Radiation Therapy. In the left anterior descending coronary artery, the dose was $25.4{\pm}5.4Gy$, which was the smallest in Intensity Modulated Radiation Therapy. The maximum dose value of the Right breast was $29.7{\pm}4.3Gy$ at Intensity Modulated Radiation Therapy. Conclusion: When comparing the values of surrounding normal organs, Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy were applicable values for treatment. Among them, Intensity Modulated Radiation Therapy is considered to be a suitable treatment planning method.