{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T07:48:43Z","timestamp":1762674523832,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T00:00:00Z","timestamp":1643932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Purpose: The dosimetric analysis of the incidental axillary dose delivered to axillary lymph node levels I\u2013III by different techniques of whole breast irradiation and the analysis of prognostic factors of axillary recurrence of breast cancer. Methods: We perform a retrospective analysis that includes 171 patients with localized breast carcinoma irradiated at Centre Paul Strauss. To be included in the study, patients had to have a histological confirmation of breast cancer diagnosis, surgical treatment without axillary lymph node dissection (ALND), whole breast irradiation without axillary irradiation by a specific field, and a treatment plan available. Results: Three patients had lymph node recurrence. There was no significant correlation between the maximal or mean dose delivered at the three axillary levels and the risk of axillary lymph node recurrence. There was no significant correlation between the irradiation technique and the risk of axillary lymph node recurrence. Two patients, both in the HT group, had lymphoedema. There was significantly more lymphoedema in the HT group than in the ST and IMRT groups (p &lt; 0.048). The mean dose in level II was significantly higher in the group of patients with lymphoedema (3.45 Gy (1.08; 9.62) vs. 23.4 Gy (23.1; 23.6)) (p &lt; 0.02). Conclusion: The irradiation technique has an influence on the incidental dose delivered to the axillary area, but has no influence on the risk of axillary recurrence. The risk of lymphoedema could be related to the use of HT and the mean dose delivered at level II.<\/jats:p>","DOI":"10.3390\/cancers14030807","type":"journal-article","created":{"date-parts":[[2022,2,6]],"date-time":"2022-02-06T20:36:47Z","timestamp":1644179807000},"page":"807","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Impact of an Incidental Dose on Axillary Tumor Control and Toxicity in Localized Breast Cancer: A Retrospective Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3969-6610","authenticated-orcid":false,"given":"Martin","family":"Schmitt","sequence":"first","affiliation":[{"name":"Radiotherapy Department, Strasbourg Europe Cancer Institute, 17 Rue Albert Calmette, 67200 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8102-771X","authenticated-orcid":false,"given":"Isabelle","family":"Chambrelant","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Strasbourg Europe Cancer Institute, 17 Rue Albert Calmette, 67200 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parigna","family":"Hong Chheang","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Khmer Soviet Friendship Hospital, Yuthapol Khemarak Phoumin Blvd, Phnom Penh 12306, Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carole","family":"Pflumio","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Strasbourg Europe Cancer Institute, 17 Rue Albert Calmette, 67200 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carole","family":"Hild","sequence":"additional","affiliation":[{"name":"Breast Surgery Department, Strasbourg Europe Cancer Institute, 17 Rue Albert Calmette, 67200 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thierry","family":"Petit","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Strasbourg Europe Cancer Institute, 17 Rue Albert Calmette, 67200 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4952-5572","authenticated-orcid":false,"given":"Georges","family":"No\u00ebl","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Strasbourg Europe Cancer Institute, 17 Rue Albert Calmette, 67200 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1067\/j.cpsurg.2016.11.003","article-title":"Trends and Controversies in Multi-Disciplinary Care of the Breast Cancer Patient","volume":"53","author":"Dominici","year":"2016","journal-title":"Curr. Probl. Surg."},{"key":"ref_2","first-page":"A9302","article-title":"Axillary lymph node dissection versus axillary radiotherapy in patients with a positive sentinel node: The AMAROS trial","volume":"159","author":"Donker","year":"2015","journal-title":"Ned. Tijdschr. Geneeskd."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.ejso.2015.05.007","article-title":"Axillary Lymph Node Dissection versus Sentinel Lymph Node Biopsy Alone for Early Breast Cancer with Sentinel Node Metastasis: A Meta-Analysis","volume":"41","author":"Li","year":"2015","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1001\/jama.2017.11470","article-title":"Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival among Women with Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial","volume":"318","author":"Giuliano","year":"2017","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"71","DOI":"10.3857\/roj.2017.00381","article-title":"Dosimetric Comparison of IMRT versus 3DCRT for Post-Mastectomy Chest Wall Irradiation","volume":"36","author":"Rastogi","year":"2018","journal-title":"Radiat. Oncol. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.compmedimag.2016.10.001","article-title":"Evaluation of 3D-CRT, IMRT and VMAT Radiotherapy Plans for Left Breast Cancer Based on Clinical Dosimetric Study","volume":"54","author":"Liu","year":"2016","journal-title":"Comput. Med. Imaging Graph."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/S0360-3016(99)00132-7","article-title":"Intensity-Modulated Tangential Beam Irradiation of the Intact Breast","volume":"44","author":"Hong","year":"1999","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.ijrobp.2013.11.232","article-title":"The Impact of Radiation Therapy on the Risk of Lymphedema after Treatment for Breast Cancer: A Prospective Cohort Study","volume":"88","author":"Warren","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4488","DOI":"10.1200\/JCO.2013.49.7842","article-title":"Randomized Controlled Trial of Intensity-Modulated Radiotherapy for Early Breast Cancer: 5-Year Results Confirm Superior Overall Cosmesis","volume":"31","author":"Mukesh","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.ijrobp.2005.12.044","article-title":"Evaluation of Two Tomotherapy-Based Techniques for the Delivery of Whole-Breast Intensity-Modulated Radiation Therapy","volume":"65","author":"Gonzalez","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.radonc.2009.07.005","article-title":"Dosimetric Assessment of Static and Helical TomoTherapy in the Clinical Implementation of Breast Cancer Treatments","volume":"93","author":"Reynders","year":"2009","journal-title":"Radiother. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/jso.21535","article-title":"Morbidity Results from the NSABP B-32 Trial Comparing Sentinel Lymph Node Dissection versus Axillary Dissection","volume":"102","author":"Ashikaga","year":"2010","journal-title":"J. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ijrobp.2018.03.046","article-title":"Radiation Therapy Field Design and Lymphedema Risk after Regional Nodal Irradiation for Breast Cancer","volume":"102","author":"Gross","year":"2018","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.ijrobp.2008.02.080","article-title":"Does Axillary Boost Increase Lymphedema Compared with Supraclavicular Radiation Alone after Breast Conservation?","volume":"72","author":"Hayes","year":"2008","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Abbassi, L.M., Ars\u00e8ne-Henry, A., Amessis, M., and Kirova, Y.M. (Cancer Radiother., 2021). Radiation Dose to the Low Axilla in Patients Treated for Early-Stage Breast Cancer by Locoregional Intensity-Modulated Radiotherapy (IMRT), Cancer Radiother., in press.","DOI":"10.1016\/j.canrad.2021.06.002"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1007\/s00066-021-01808-y","article-title":"Incidental Axillary Dose Delivery to Axillary Lymph Node Levels I-III by Different Techniques of Whole-Breast Irradiation: A Systematic Literature Review","volume":"197","author":"Schmitt","year":"2021","journal-title":"Strahlenther. Onkol."},{"key":"ref_17","unstructured":"Schmitt, M., Chambrelant, I., Pflumio, I., Hild, C., Petit, T., and No\u00ebl, G. (Cancer Radiother., 2022). A retrospective analysis of survival and prognostic factors of axillary recurrence of breast cancer, Cancer Radiother., Under review."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.radonc.2014.11.030","article-title":"ESTRO Consensus Guideline on Target Volume Delineation for Elective Radiation Therapy of Early Stage Breast Cancer","volume":"114","author":"Offersen","year":"2015","journal-title":"Radiother. Oncol."},{"key":"ref_19","unstructured":"Hennequin, C. (2021, September 08). Le Rapport Alpha\/B\u00eata Revisit\u00e9 \u00e0 L\u2019heure de L\u2019hypofractionnement. Available online: https:\/\/www.em-consulte.com\/article\/837910\/le-rapport-alphabeta-revisite-a-l-heure-de-l-hypof."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.radonc.2019.08.021","article-title":"Irradiation of Regional Lymph Node Areas in Breast Cancer\u2014Dose Evaluation According to the Z0011, AMAROS, EORTC 10981-22023 and MA-20 Field Design","volume":"142","author":"Borm","year":"2020","journal-title":"Radiother. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ijrobp.2004.04.065","article-title":"Analysis of Axillary Coverage during Tangential Radiation Therapy to the Breast","volume":"61","author":"Reznik","year":"2005","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3758","DOI":"10.1245\/s10434-014-3966-1","article-title":"Breast Radiotherapy (RT) Using Tangential Fields (TgF): A Prospective Evaluation of the Dose Distribution in the Sentinel Lymph Node (SLN) Area as Determined Intraoperatively by Clip Placement","volume":"21","author":"Belkacemi","year":"2014","journal-title":"Ann. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e4036","DOI":"10.1097\/MD.0000000000004036","article-title":"Dosimetric Evaluation of Incidental Irradiation to the Axilla during Whole Breast Radiotherapy for Patients with Left-Sided Early Breast Cancer in the IMRT Era","volume":"95","author":"Lee","year":"2016","journal-title":"Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1259\/bjr\/25788274","article-title":"Coverage of Axillary Lymph Nodes with High Tangential Fields in Breast Radiotherapy","volume":"83","author":"Ercan","year":"2010","journal-title":"Br. J. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.ijrobp.2008.10.034","article-title":"Variability of Target and Normal Structure Delineation for Breast Cancer Radiotherapy: An RTOG Multi-Institutional and Multiobserver Study","volume":"73","author":"Li","year":"2009","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s10549-005-9025-7","article-title":"Post-Operative Arm Morbidity and Quality of Life. Results of the ALMANAC Randomised Trial Comparing Sentinel Node Biopsy with Standard Axillary Treatment in the Management of Patients with Early Breast Cancer","volume":"95","author":"Fleissig","year":"2006","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1002\/bjs.7360","article-title":"Systematic Review of the Effect of External Beam Radiation Therapy to the Breast on Axillary Recurrence after Negative Sentinel Lymph Node Biopsy","volume":"98","author":"Teerenstra","year":"2011","journal-title":"Br. J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1056\/NEJMoa022152","article-title":"Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer","volume":"347","author":"Fisher","year":"2002","journal-title":"N. Engl. J. Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/3\/807\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:14:22Z","timestamp":1760134462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/3\/807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,4]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["cancers14030807"],"URL":"https:\/\/doi.org\/10.3390\/cancers14030807","relation":{},"ISSN":["2072-6694"],"issn-type":[{"type":"electronic","value":"2072-6694"}],"subject":[],"published":{"date-parts":[[2022,2,4]]}}}