title: Pretreatment staging positron emission tomography/computed tomography in patients with inflammatory breast cancer influences radiation treatment field designs.
abstract: OBJECTIVE
  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
  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.
authors.affiliation: Department of Radiation Oncology, The Morgan Welch Inflammatory Breast Cancer Clinic, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Gary V
authors.initials: GV
authors.lastname: Walker
authors.forename: Naoki
authors.initials: N
authors.lastname: Niikura
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Eric
authors.initials: E
authors.lastname: Rohren
authors.forename: Vicente
authors.initials: V
authors.lastname: Valero
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Woodward
authors.forename: Ricardo H
authors.initials: RH
authors.lastname: Alvarez
authors.forename: Anthony
authors.initials: A
authors.lastname: Lucci
authors.forename: Naoto T
authors.initials: NT
authors.lastname: Ueno
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001940:Breast / Q000000981:diagnostic imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D015182:Lymphatic Irradiation; D008408:Mastectomy; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography; D011182:Postoperative Care / Q000379:methods; D019275:Radiopharmaceuticals; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012115:Residual Volume; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18