title: [Controversy about internal mammary chain irradiation in breast cancer].
abstract: Irradiation of lymph nodes areas after surgery of breast cancer, and specifically of the internal mammary chain, is an open question, frequently discussed. Three randomised trials (French, European-EORTC, Canadian) have been recently published or presented. The French trial did not show any benefit for internal mammary chain irradiation, but it was probably underpowered. The EORTC and Canadian trials demonstrated an improvement in overall survival after lymph nodes irradiation, including the internal mammary chain. The absolute benefit is 1.6% (hazard ratio-0.88 in a recent meta-analysis). Because this benefit is limited, it is important to define the characteristics of the patients who may benefit from this irradiation. Analyses of the randomized trials are not complete, and it is difficult at this moment to accurately define this population. However, cardiac and pulmonary toxicity of lymph nodes irradiation is well known. For each patient, evaluation of the potential late toxicity must be evaluated and so an accurate dosimetry for critical organs must be performed: the indication of internal mammary chain irradiation depends of the benefit/risk ratio.
authors.affiliation: Service de radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75010 Paris, France. Electronic address: christophe.hennequin@sls.aphp.fr.
authors.forename: C
authors.initials: C
authors.lastname: Hennequin
authors.affiliation: Département de radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Fourquet
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects; D015182:Lymphatic Irradiation / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D015412:Mastectomy, Segmental; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D058958:Organs at Risk; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology; D011874:Radiometry; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Breast cancer; Cancer du sein; Chaîne mammaire interne; Essai randomisé; Internal mammary chain; Radiotherapy; Radiothérapie; Randomized trial