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KMID : 0859320070250040261
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Journal of the Korean Society for Therapeutic Radiology and Oncology
2007 Volume.25 No. 4 p.261 ~ p.267
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Internal Mammary Lymph Node Irradiation after Breast Conservation Surgery: Radiation Pneumonitis versus Dose?Volume Histogram Parameters
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Kim Ju-Young
Jeong Kyoung-Keun
Keum Ki-Chang
Lee Ik-Jae
Shim Su Jung
Suh Chang-Ok
Kim Yong-Bae
Kim Jong-Dae
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Abstract
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Purpose: To evaluate the association between radiation pneumonitis and dose-volume histogram parameters
and to provide practical guidelines to prevent radiation pneumonitis following radiotherapy administered for breast
cancer including internal mammary lymph nodes.
Materials and Methods: Twenty patients with early breast cancer who underwent a partial mastectomy were
involved in this study. The entire breast, supraclavicular lymph nodes, and internal mammary lymph nodes were
irradiated with a dose of 50.4 Gy in 28 fractions. Radiation pneumonitis was assessed by both radiological
pulmonary change (RPC) and by evaluation of symptomatic radiation pneumonitis. Dose-volume histogram
parameters were compared between patients with grade ＜2 RPC and those with grade ≥2 RPC. The
parameters were the mean lung dose, V10 (percent lung volume receiving equal to and more than 10 Gy), V20,
V30, V40, and normal tissue complication probability (NTCP).
Results: Of the 20 patients, 9 (45%) developed grade 2 RPC and 11 (55%) did not develop RPC (grade 0). Only
one patient developed grade 1 symptomatic radiation pneumonitis. Univariate analysis showed that among the
dose-volume histogram parameters, NTCP was significantly different between the two RPC grade groups (p
＜0.05). Fisher’s exact test indicated that an NTCP value of 45% was appropriate as an RPC threshold level.
Conclusion: This study shows that NTCP can be used as a predictor of RPC after radiotherapy of the internal
mammary lymph nodes in breast cancer. Clinically, it indicates that an RPC is likely to develop when the NTCP
is greater than 45%
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KEYWORD
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Breast cancer, Internal mammary lymph node, Radiation pneumonitis, Radiotherapy
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