title: Comparison of two treatment strategies for irradiation of regional lymph nodes in patients with breast cancer: Lymph flow guided portals versus standard radiation fields.
abstract: OBJECTIVE
  Radiotherapy being an essential part of breast cancer treatment, we evaluate various radiotherapy strategies in patients with breast cancer.
  
  
  METHODS
  Lymph node (LN) scintigraphy was performed in 172 primary patients with BC. LN visualization started 30-360 min after intratumoral injection of 75-150 MBq of 99mTc-nanocolloids. Our standard recommendation for postoperative radiotherapy in patients with LN invasion by BC were as follows: for patients with external localization of tumour - breast + axillary (Ax) + sub-supraclavicular (SSCL) regions; with internal localization - all above + internal mammary nodes (IM). Proposed strategy of lymph flow guided radiotherapy is based on the assumption that only regions that contain 'hot' LNs must be included in a treatment volume.
  
  
  RESULTS
  Among 110 patients with external localization of BC, Ax LNs were visualized in all cases and in 62 patients it was the only region with 'hot' LN. Twenty-three patients (20.9%) had drainage to Ax + SSCL, 12 (10.9%) - Ax + IM, 13 (11.8%) - Ax + SSCL + IM regions. After the visualization of lymph flow patterns, standard treatment volume was changed in 87/110 cases (79.1%): in 56.4%, reduced, in 22.7%, enlarged or changed. In 62 patients with tumours in internal quadrants, we revealed the following patterns of lymph-flow: only to the Ax region in 23 (37.1%); Ax + IM, 13 (21%); Ax + SSCL, 15 (24.2%); Ax + IM + ISSCL, 11 (17.7%) cases. After lymph-flow visualization, the standard irradiation volume was reduced in 53/62 (85.5%) cases.
  
  
  CONCLUSIONS
  Visualization of an individual lymph flow pattern from BC can be used for the optimization of standard fields used for irradiation of regional LNs.
authors.affiliation: Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya, 68, Pesochny-2, 194291 St. Petersburg, Russia.
authors.forename: Sergey Nikolaevich
authors.initials: SN
authors.lastname: Novikov
authors.affiliation: Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya, 68, Pesochny-2, 194291 St. Petersburg, Russia.
authors.forename: Sergey Vasilevich
authors.initials: SV
authors.lastname: Kanaev
authors.affiliation: Department of Surgery No. 1 (Breast Cancer), N.N. Petrov Institute Oncology, Leningradskaya, 68, Pesochny-2, 194291 St. Petersburg, Russia.
authors.forename: Vladimir Fedorovich
authors.initials: VF
authors.lastname: Semiglazov
authors.affiliation: Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya, 68, Pesochny-2, 194291 St. Petersburg, Russia.
authors.forename: Ludmila Alekseevna
authors.initials: LA
authors.lastname: Jukova
authors.affiliation: Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya, 68, Pesochny-2, 194291 St. Petersburg, Russia.
authors.forename: Pavel Ivanovich
authors.initials: PI
authors.lastname: Krzhivitckiy
keywords: Breast cancer; Radiotherapy; Sentinel lymph-nodes