Pretreatment staging positron emission tomography/computed tomography in patients with inflammatory breast cancer influences radiation treatment field designs

Autor: Naoki Niikura, Wei Yang, Wendy A. Woodward, Vicente Valero, Anthony Lucci, Naoto T. Ueno, Gary V. Walker, Eric M. Rohren, Ricardo H. Alvarez, Thomas A. Buchholz
Rok vydání: 2011
Předmět:
Adult
Cancer Research
medicine.medical_specialty
medicine.medical_treatment
Inflammatory breast cancer
Multimodal Imaging
Fluorodeoxyglucose F18
medicine
Mammography
Breast MRI
Humans
Radiology
Nuclear Medicine and imaging
Breast
skin and connective tissue diseases
Mastectomy
Aged
Neoplasm Staging
Retrospective Studies
Postoperative Care
Radiation
Lymphatic Irradiation
medicine.diagnostic_test
business.industry
Radiotherapy Planning
Computer-Assisted
Middle Aged
medicine.disease
Radiation therapy
Residual Volume
Axilla
medicine.anatomical_structure
Oncology
Positron emission tomography
Positron-Emission Tomography
Female
Inflammatory Breast Neoplasms
Radiology
Lymph Nodes
Radiopharmaceuticals
Supraclavicular fossa
Nuclear medicine
business
Tomography
X-Ray Computed
Emission computed tomography
Zdroj: International journal of radiation oncology, biology, physics. 83(5)
ISSN: 1879-355X
Popis: Purpose Positron emission tomography/computed tomography (PET/CT) is increasingly being utilized for staging of inflammatory breast cancer (IBC). The purpose of this study was to define how pretreatment PET/CT studies affected postmastectomy radiation treatment (PMRT) planning decisions for IBC. Methods and Materials We performed a retrospective analysis of 62 patients diagnosed with IBC between 2004 and 2009, who were treated with PMRT in our institution and who had a staging PET/CT within 3 months of diagnosis. Patients received a baseline physical examination, staging mammography, ultrasonographic examination of breast and draining lymphatics, and chest radiography; most patients also had a bone scan (55 patients), liver imaging (52 patients), breast MRI (46 patients), and chest CT (25 patients). We compared how PET/CT findings affected PMRT, assuming that standard PMRT would target the chest wall, level III axilla, supraclavicular fossa, and internal mammary chain (IMC). Any modification of target volumes, field borders, or dose prescriptions was considered a change. Results PET/CT detected new areas of disease in 27 of the 62 patients (44%). The areas of additional disease included the breast (1 patient), ipsilateral axilla (1 patient), ipsilateral supraclavicular (4 patients), ipsilateral infraclavicular (1 patient), ipsilateral IMC (5 patients), ipsilateral subpectoral (3 patients), mediastinal (8 patients), other distant/contralateral lymph nodes (15 patients), or bone (6 patients). One patient was found to have a non-breast second primary tumor. The findings of the PET/CT led to changes in PMRT in 11 of 62 patients (17.7%). These changes included additional fields in 5 patients, adjustment of fields in 2 patients, and higher doses to the supraclavicular fossa (2 patients) and IMC (5 patients). Conclusions For patients with newly diagnosed IBC, pretreatment PET/CT provides important information concerning involvement of locoregional lymph nodes, mediastinal lymph nodes, and unsuspected sites of distant metastasis. This information is important in the design of radiotherapy treatment fields and, therefore, we recommend that PET/CT be a component of initial staging for IBC.
Databáze: OpenAIRE
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