The Role of Internal Mammary Node Radiation as Part of Modern Breast Cancer Radiotherapy: A Systematic Review
A partir d'une revue systématique de la littérature publiée entre 1994 et 2015 (16 articles), cette étude analyse le rôle d'une radiothérapie de la chaîne ganglionnaire mammaire interne dans le traitement des cancers du sein
Background : Despite data from multiple randomized trials, the role of internal mammary lymph node irradiation as part of regional nodal irradiation (IMLN RT–RNI) remains unanswered. Recent noteworthy literature and modern RT techniques may identify a subset of patients who benefit from IMLN RT–RNI, lending insight into the balance between improved outcomes and acceptable toxicity. We evaluated the current role of IMLN RT–RNI by analyzing randomized, prospective, and retrospective data. Methods : In accordance with PRISMA guidelines, a literature review was performed using PubMed evaluating published studies from 1994 to 2015. Information evaluated included the number of patients, length of follow-up, technical aspects of RT, and outcomes (clinical outcomes, complications/toxicity). Results : Sixteen articles (four randomized, four nonrandomized, seven retrospective, and one meta-analysis) were included. While older randomized trials failed to show differences in clinical outcomes or toxicity with IMLN RT–RNI, recent randomized data suggest the potential for improved outcomes, including overall survival, with IMLN RT–RNI. Further, non-randomized data have suggested a potential benefit for central tumors with IMLN RT–RNI. Although recent data suggest a potential increase in pulmonary complications with IMLN RT–RNI with the utilization of advanced radiation techniques, toxicity rates remain low with limited cardiac toxicity data available. Conclusions : Increasing data support the utilization of IMLN RT–RNI based on recent randomized trials. IMLN RT may be considered based on the inclusion of IMLN RT as part of RNI in recent trials, based on the inclusion criteria from IMLN RT–RNI trials, or with patients with centromedial tumors and axillary disease.