title: The standard tangential fields used for breast irradiation do not allow optimal coverage and dose distribution in axillary levels I-II and the sentinel node area.
abstract: BACKGROUND
  Recent data from ACOSOG Z0011 and NSABP B32 trials suggested no need for axillary lymph node dissection (ALND) in patients with micrometastatic involvement of the sentinel lymph node (SLN). The low rate of axillary recurrence was attributed to the axilla coverage by the tangential fields (TgFs) irradiation and systemic therapy. This study aimed to evaluate dose distribution and coverage of the axilla levels I-II and the SLN area.
  
  
  METHODS
  One hundred and nine patients were analyzed according to three groups: group 1 (50 Gy; n = 18), group 2 (60 Gy; n = 34) and group 3 (66 Gy; n = 57). Patients were treated using the standard (STgF; n = 22) or high (HTgF; n = 87) TgF.
  
  
  RESULTS
  The median doses delivered to level I using HTgF versus STgF were 33 and 20 Gy (P = 0.0001). The mean dose delivered to the SLN area was only 28 Gy. Additionally, the SLN area was totally included in the HTgF in 1 out of 12 patients who had intraoperative clip placement in the SNL area.
  
  
  CONCLUSIONS
  TgFs provide a limited coverage of the axilla and the SNLB area. This information should be considered when only TgFs are planned to target the axilla in patients with a positive SLN without ALND. Standardization of locoregional radiotherapy in this situation is urgently needed.
authors.affiliation: Department of Radiation Oncology, Henri Mondor Breast Center, AP-HP, GH Henri Mondor, University of Paris-Est Créteil (UPEC), Créteil, France. yazid.belkacemi@hmn.aphp.fr
authors.forename: Y
authors.initials: Y
authors.lastname: Belkacemi
authors.forename: Q
authors.initials: Q
authors.lastname: Allab-Pan
authors.forename: V
authors.initials: V
authors.lastname: Bigorie
authors.forename: W
authors.initials: W
authors.lastname: Khodari
authors.forename: P
authors.initials: P
authors.lastname: Beaussart
authors.forename: J-L
authors.initials: JL
authors.lastname: Totobenazara
authors.forename: J-P
authors.initials: JP
authors.lastname: Mège
authors.forename: P
authors.initials: P
authors.lastname: Caillet
authors.forename: F
authors.initials: F
authors.lastname: Pigneur
authors.forename: T-H
authors.initials: TH
authors.lastname: Dao
authors.forename: R
authors.initials: R
authors.lastname: Salmon
authors.forename: E
authors.initials: E
authors.lastname: Calitchi
authors.forename: R
authors.initials: R
authors.lastname: Bosc
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D013534:Survival; D015996:Survival Rate
keywords: AROME; axilla levels; breast cancer; radiotherapy; sentinel node; tangential fields