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2022-RA-1352-ESGO Dose received by axillary lymph nodes in breast cancer adjuvant radiotherapy
  1. Najla Attia1,
  2. Sabrine Tbessi2,
  3. Azhar Oualha1,
  4. Fadoua Bouguerra2,
  5. Baouader Amri1,
  6. Raouf Hammouda3,
  7. Samia Kanoun Belajouza1,
  8. Nadia guetari Bouzid3 and
  9. Sameh Tebra3
  1. 1Radiotherapy, Farhat Hached’s Hospital, Sousse, Tunisia
  2. 2Radiotherapy, Hopital Farhat Hached, Sousse, Tunisia
  3. 3Radiotherapy, farhat hached, Sousse, Tunisia


Introduction/Background The axillary region is considered problematic; a risked organ (OAR), a predictive dosimetric parameter of long-term lymphedema, and a residual-disease site in case of breast-cancer radiotherapy.Our study endeavors to determine the dose received by the axillary area in adjuvant radiotherapy for breast-cancer and to assess its clinical impact on long-term lymphedema.

Methodology A retrospective dosimetric study, executed in the radiotherapy department of Farhat Hached Hospital, Sousse, included 50 female patients treated with three-dimensional adjuvant radiotherapy for breast-cancer, between 2018 and 2019. The axillary-area was delineated according to the European-Organization for Research and Treatment of Cancer(EORTC) guidelines.

Results The average age was 52[30–80]. 64% of our patients had a mastectomy with ipsilateral axillary lymph-node dissection(IALND), while 36% had a lumpectomy with a IALND. 35 patients(70%) received regional radiotherapy and 15 patients(30%) had only local radiotherapy with 2 tangential fields. All the patients were treated with normofractionated radiotherapy dose of 50Gy. Patients with conservative surgical treatment or T4 classified tumors received an additional boost; 66Gy (21patients) and 70Gy for tumoral-surgical limits (1patient). The mean axillary volume was 77.9 cm3[9.4–181]. The mean-dose, the maximal-dose and the minimal-dose received by the axillary region were respectively 28.49Gy[3.19–53.7Gy], 54.18Gy[33.96–72.63Gy] and 9.4Gy[0.32–10.74Gy].Late complications of lymphedema and radio induced dermatitis (GI and II according to the CTCAEV5.0scale) were observed respectively in 6(12%) and 17(34%) patients.

Conclusion To conclude, the axillary-area received unintentional and significant doses during breast-irradiation; by the tangential fields or the additional supraclavicular field. Some authors consider that the axillary-lateral thoracic vessel junction (ALTJ); that’s above level I Berg, as an OAR for long-term lymphedema and its dose can be minimized especially for clinically node-negative patients. Further validation of lymphedema OAR dosimetric parameters by prospective studies is justified.

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