The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
József Pap Szekeres - One of the best experts on this subject based on the ideXlab platform.
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Internal Mammary lymph Nodes and sentinel Node biopsy in breast cancer.
Surgical Oncology-oxford, 2001Co-Authors: Gábor Cserni, József Pap SzekeresAbstract:Abstract The long-term follow-up of patients treated with extended radical mastectomy has proved that the Internal Mammary Node (IMN) status is an important prognosticator of breast cancer. Patients with isolated IMN involvement seem to have the same outcome as those with limited axillary disease, and these patients may therefore be overstaged in the TNM system. Sentinel Node biopsy (SNB) of IMNs may be an ideal staging procedure, but lymphatic mapping studies demonstrate that data from extended radical mastectomy series cannot be extrapolated to patients suitable for SNB, where the IMN involvement is
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Internal Mammary lymph Nodes and sentinel Node biopsy in breast cancer
Surgical Oncology-oxford, 2001Co-Authors: Gábor Cserni, József Pap SzekeresAbstract:The long-term follow-up of patients treated with extended radical mastectomy has proved that the Internal Mammary Node (IMN) status is an important prognosticator of breast cancer. Patients with isolated IMN involvement seem to have the same outcome as those with limited axillary disease, and these patients may therefore be overstaged in the TNM system. Sentinel Node biopsy (SNB) of IMNs may be an ideal staging procedure, but lymphatic mapping studies demonstrate that data from extended radical mastectomy series cannot be extrapolated to patients suitable for SNB, where the IMN involvement is <5% overall, and around 1% for IMN metastases without axillary disease. Current evidence does not allow Internal Mammary SNB to be recommended as a standard procedure, but as patients with IMN involvement may benefit from adjuvant systemic treatment, Internal Mammary SNB should be further studied in this context.
Seung Jae Huh - One of the best experts on this subject based on the ideXlab platform.
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does Internal Mammary Node irradiation affect treatment outcome in clinical stage ii iii breast cancer patients receiving neoadjuv ant chemotherapy
Breast Cancer Research and Treatment, 2015Co-Authors: Kyung Hwan Kim, Yong Bae Kim, Jae Myoung Noh, Jee Suk Chang, Ki Chang Keum, Seung Jae Huh, Doo Ho Choi, Won Park, Chang Ok SuhAbstract:The purpose of this study is to assess the value of Internal Mammary Node irradiation (IMNI) in patients receiving postoperative radiotherapy after neoadjuvant chemotherapy (NAC) using modern systemic therapy. Between 2001 and 2009, 521 consecutive patients with clinical stage II–III breast cancer received NAC and postoperative radiotherapy. With a consistent policy, the treating radiation oncologist either included (N = 284) or excluded (N = 237) the Internal Mammary Node in the treatment volume. Anthracycline- and taxane-based chemotherapy was provided to 482 (92.5 %) patients. To account for the unbalanced characteristics between the two groups, we performed propensity score matching and covariate adjustment using the propensity score. The median follow-up duration was 71 months (range 31–153 months). The 5-year disease-free survival (DFS) with and without IMNI was 81.8 and 72.7 %, respectively (p = 0.019). The benefit of IMNI varied according to patient characteristics such that it was more apparent in patients with N1–2 disease, inner/central location, and triple-negative subtype. After adjusting for all potential confounding variables, IMNI was independently associated with improved DFS (p = 0.049). The significant effect of IMNI on DFS was sustained after propensity score matching (p = 0.040) and covariate adjustment using the propensity score (p = 0.048). Symptomatic radiation pneumonitis developed in 9 (3.2 %) patients receiving IMNI. Our results indicated that IMNI was associated with a significant improvement in DFS with low toxicity rate for breast cancer patients receiving NAC. Further prospective studies are warranted to confirm the effect of IMNI in the NAC setting.
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long term survival outcomes following Internal Mammary Node irradiation in stage ii iii breast cancer results of a large retrospective study with 12 year follow up
International Journal of Radiation Oncology Biology Physics, 2013Co-Authors: Jee Suk Chang, Yong Bae Kim, Ki Chang Keum, Doo Ho Choi, Won Park, Chang Ok Suh, Ik Jae Lee, Chang Geol Lee, Seung Jae HuhAbstract:Purpose To examine the effect of Internal Mammary Node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in breast cancer patients treated with modified radical mastectomy and postoperative radiation therapy. Methods and Materials Between 1994 and 2002, 396 patients with stage II-III breast cancer were treated with postmastectomy radiation therapy with (n=197) or without (n=199) IMNI. Patients who received neoadjuvant chemotherapy were excluded. IMNI was administered at the clinical discretion of the treating physician. Median RT dose was 50.4 Gy (range, 45.0-59.4 Gy) in 28 fractions, with inclusion of the supraclavicular fossa in 96% of patients. Adjuvant chemotherapy was administered to 99.7% of the patients and endocrine therapy to 53%. Results The median follow-up was 149 months (range, 124-202). IMNI patients had more advanced nodal stage and non-high grade tumors than those without IMNI ( P P =.05). Multivariate analysis demonstrated that IMNI was an independent, positive predictor of DFS (hazard ratio [HR], 0.70; P =.02). Benefits of IMNI in DFS were seen most apparently in N2 patients (HR, 0.44; 95% confidence interval [CI], 0.26-0.74) and inner/central tumors (HR, 0.55; 95% CI, 0.34-0.90). The 10-year OS with and without IMNI was 72% and 66%, respectively ( P =.62). The 10-year DFS and OS were 61%, and 69%, respectively. Conclusions Internal Mammary Node irradiation significantly improved DFS in postmastectomy breast cancer patients. Pending long-term results from randomized trials, treatment of Internal Mammary Nodes should be considered in postmastectomy radiation therapy.
Yong Bae Kim - One of the best experts on this subject based on the ideXlab platform.
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Internal Mammary Node Irradiation in Node-Positive Breast Cancer Treated with Mastectomy and Taxane-Based Chemotherapy
2021Co-Authors: Won Kyung Cho, Yong Bae Kim, Jee Suk Chang, Doo Ho Choi, Won Park, Seung Gyu Park, Nalee Kim, Haeyoung Kim, Chang Ok SuhAbstract:Abstract Purpose: It is important to continually reevaluate the risk/benefit calculus of Internal Mammary Node irradiation (IMNI) in the era of modern systemic therapy. We aimed to investigate the effect of IMNI on survival in Node-positive breast cancer treated with mastectomy and anthracycline plus taxane-based chemotherapy.Methods and Materials: We analyzed 348 patients who underwent mastectomy and anthracycline plus taxane-based chemotherapy for Node-positive breast cancer between January 2006 and December 2011. All patients received adjuvant radiotherapy with IMNI (n = 105, 30.2%) or without IMNI (n = 243, 69.8%). The benefit of IMNI for disease-free survival (DFS) and overall survival (OS) was evaluated using multivariate analysis and inverse probability of treatment weighting (IPTW) to adjust for unbalanced covariates between the groups.Results: After a median follow-up of 95 months, the 10-year locoregional recurrence-free survival rate, DFS, and OS in all patients were 94.8%, 77.4%, and 86.2%, respectively. The IPTW-adjusted hazard ratio (HR) for the association of IMNI (vs. no IMNI) with DFS and OS was 0.208 (95% confidence intervals (CI) 0.045–0.966) and 0.460 (95% CI, 0.220-0.962). In multivariate analysis, IMNI was a favorable factor for DFS (HR, 0.458; p = 0.021) and OS (HR 0.233, p = 0.018).Conclusions: IMNI was associated with improved DFS and OS in Node-positive patients treated with mastectomy, post-mastectomy radiation therapy, and taxane-based chemotherapy, although the rate of locoregional recurrence was low.
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individual case review in a phase 3 randomized trial to investigate the role of Internal Mammary lymph Node irradiation for breast cancer korean radiation oncology group 08 06 study
Radiotherapy and Oncology, 2017Co-Authors: Hong In Yoon, Jeongmin Yoon, Yoonsun Chung, Chung Mo Nam, Hyejung Cha, Jinhyun Choi, Jeongshim Lee, Hee Ji Han, Yeona Cho, Yong Bae KimAbstract:Abstract Purpose/objective This study aimed to assess protocol compliance based on an individual case review (ICR) of the Korean Radiation Oncology Group-0806 trial. Methods and materials For the ICR, 747 participants were divided into eight subgroups based on Internal Mammary Node irradiation (IMNI), tumor laterality, and surgery type. Next, 15% of patients were randomly selected within each subgroup, and corresponding hospitals were subsequently requested to upload information related to radiation therapy (RT) planning. We reviewed the dose distributions of targets and organs at risk to determine protocol compliance. Results Data of 102 patients were collected. Overall, RT plans were found to be mostly protocol-compliant, with acceptability rates of 60–80% despite deviations in the ipsilateral lung in Arm 2 (IMNI group). However, despite few deviations, a subgroup analysis revealed significant differences in protocol compliance. Among RT techniques, plans using standard and partial wide tangents were most compliant in both Arms. In this ICR, the estimated survival benefits based on IMN doses were 7.7%, 8.4%, and 7.2% for all, breast-conserving surgery, and mastectomy cases, respectively. Conclusion This ICR demonstrated overall protocol compliance, despite significant differences with regard to IMN irradiation and organs at risk according to subgroups and adopted field arrangements.
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radiation pneumonitis in association with Internal Mammary Node irradiation in breast cancer patients an ancillary result from the krog 08 06 study
Journal of Breast Cancer, 2016Co-Authors: Jinhyun Choi, Yong Bae Kim, Kyung Hwan Shin, Sung Ja Ahn, Hyungsik Lee, Won Soon Park, Su Ssan Kim, Jin Hee Kim, Kyu Chan Lee, Dong Won KimAbstract:Purpose The aim of this study is to present the incidence of radiation pneumonitis (RP) reported within 6 months after treatment for breast cancer with or without Internal Mammary Node irradiation (IMNI). Methods In the Korean Radiation Oncology Group (KROG) 08-06 phase III randomized trial, patients who were Node-positive after surgery were randomly assigned to receive radiotherapy either with or without IMNI. A total of 747 patients were enrolled, and three-dimensional treatment planning with computed tomography simulation was performed for all patients. Of the 747 patients, 722 underwent chest X-rays before and within 6 months after radiotherapy. These 722 patients underwent evaluation, and RP was diagnosed on the basis of chest radiography findings and clinical symptoms. The relationship between the incidence of RP and clinical/dosimetric parameters was analyzed. Results RP developed in 35 patients (4.8%), including grade 1 RP in 26 patients (3.6%), grade 2 RP in nine patients (1.2%); there was no incidence of grade 3 or higher RP. Grade 2 RP cases were observed in only the IMNI group. The risk of developing RP was influenced by IMNI treatment; pneumonitis occurred in 6.5% of patients (n=23/356) who underwent IMNI and in 3.3% of patients (n=12/366) who did not (p=0.047). The differences in lung dosimetric parameters (mean lung dose, V10-40) were statistically significant between the two groups. Conclusion IMNI treatment resulted in increased radiation exposure to the lung and a higher rate of RP, but the incidence and severity of RP was minimal and acceptable. This minor impact on morbidity should be balanced with the impact on survival outcome in future analyses.
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does Internal Mammary Node irradiation affect treatment outcome in clinical stage ii iii breast cancer patients receiving neoadjuv ant chemotherapy
Breast Cancer Research and Treatment, 2015Co-Authors: Kyung Hwan Kim, Yong Bae Kim, Jae Myoung Noh, Jee Suk Chang, Ki Chang Keum, Seung Jae Huh, Doo Ho Choi, Won Park, Chang Ok SuhAbstract:The purpose of this study is to assess the value of Internal Mammary Node irradiation (IMNI) in patients receiving postoperative radiotherapy after neoadjuvant chemotherapy (NAC) using modern systemic therapy. Between 2001 and 2009, 521 consecutive patients with clinical stage II–III breast cancer received NAC and postoperative radiotherapy. With a consistent policy, the treating radiation oncologist either included (N = 284) or excluded (N = 237) the Internal Mammary Node in the treatment volume. Anthracycline- and taxane-based chemotherapy was provided to 482 (92.5 %) patients. To account for the unbalanced characteristics between the two groups, we performed propensity score matching and covariate adjustment using the propensity score. The median follow-up duration was 71 months (range 31–153 months). The 5-year disease-free survival (DFS) with and without IMNI was 81.8 and 72.7 %, respectively (p = 0.019). The benefit of IMNI varied according to patient characteristics such that it was more apparent in patients with N1–2 disease, inner/central location, and triple-negative subtype. After adjusting for all potential confounding variables, IMNI was independently associated with improved DFS (p = 0.049). The significant effect of IMNI on DFS was sustained after propensity score matching (p = 0.040) and covariate adjustment using the propensity score (p = 0.048). Symptomatic radiation pneumonitis developed in 9 (3.2 %) patients receiving IMNI. Our results indicated that IMNI was associated with a significant improvement in DFS with low toxicity rate for breast cancer patients receiving NAC. Further prospective studies are warranted to confirm the effect of IMNI in the NAC setting.
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long term survival outcomes following Internal Mammary Node irradiation in stage ii iii breast cancer results of a large retrospective study with 12 year follow up
International Journal of Radiation Oncology Biology Physics, 2013Co-Authors: Jee Suk Chang, Yong Bae Kim, Ki Chang Keum, Doo Ho Choi, Won Park, Chang Ok Suh, Ik Jae Lee, Chang Geol Lee, Seung Jae HuhAbstract:Purpose To examine the effect of Internal Mammary Node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in breast cancer patients treated with modified radical mastectomy and postoperative radiation therapy. Methods and Materials Between 1994 and 2002, 396 patients with stage II-III breast cancer were treated with postmastectomy radiation therapy with (n=197) or without (n=199) IMNI. Patients who received neoadjuvant chemotherapy were excluded. IMNI was administered at the clinical discretion of the treating physician. Median RT dose was 50.4 Gy (range, 45.0-59.4 Gy) in 28 fractions, with inclusion of the supraclavicular fossa in 96% of patients. Adjuvant chemotherapy was administered to 99.7% of the patients and endocrine therapy to 53%. Results The median follow-up was 149 months (range, 124-202). IMNI patients had more advanced nodal stage and non-high grade tumors than those without IMNI ( P P =.05). Multivariate analysis demonstrated that IMNI was an independent, positive predictor of DFS (hazard ratio [HR], 0.70; P =.02). Benefits of IMNI in DFS were seen most apparently in N2 patients (HR, 0.44; 95% confidence interval [CI], 0.26-0.74) and inner/central tumors (HR, 0.55; 95% CI, 0.34-0.90). The 10-year OS with and without IMNI was 72% and 66%, respectively ( P =.62). The 10-year DFS and OS were 61%, and 69%, respectively. Conclusions Internal Mammary Node irradiation significantly improved DFS in postmastectomy breast cancer patients. Pending long-term results from randomized trials, treatment of Internal Mammary Nodes should be considered in postmastectomy radiation therapy.
R E Mansel - One of the best experts on this subject based on the ideXlab platform.
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clinical relevance of Internal Mammary Node drainage in sentinel Node biopsy for breast cancer
Journal of Clinical Oncology, 2005Co-Authors: Amit Goyal, R G Newcombe, R E ManselAbstract:519 Background: This study was designed to identify the frequency of Internal Mammary(IM) drainage in patients undergoing sentinel Node biopsy(SNB) in a controlled clinical trial. The clinical relevance of Internal Mammary SNB as a method to improve nodal staging and treatment in breast cancer is investigated. Methods: A total of 1,139 patients with invasive breast cancer underwent SNB based on a standardised protocol using Tc 99m albumin colloid and Patent Blue V injected peritumorally. In 707 patients who participated in the validation phase, SNB was followed by standard axillary treatment in the same operation. Results: Lymphoscintigraphy showed IM sentinel Nodes in 106 patients(9%), and IM drainage was identified perioperatively in an additional 14 patients(1%) using the gamma probe. Sampling of the IM basin, was done in 60 of the 120 patients (50%) with IM drainage. Three patients had a pneumothorax and 3 experienced bleeding during IM sampling. IM metastases were detected in 8 of the 60 patients(13%...
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Internal Mammary Node drainage and its role in sentinel lymph Node biopsy the initial almanac experience
Clinical Breast Cancer, 2004Co-Authors: R E Mansel, Amit Goyal, R G NewcombeAbstract:This study was designed to identify the frequency of Internal Mammary drainage in patients undergoing sentinel lymph Node (SLN) lymphoscintigraphy in a controlled clinical trial. The practicability and relevance of Internal Mammary SLN biopsy as a method to improve nodal staging and treatment in breast cancer were investigated. A total of 707 evaluable patients with invasive breast cancer underwent SLN biopsy based on lymphoscintigraphy, intraoperative γ probe detection, and blue dye mapping using technetium Tc 99m albumin colloid and Patent Blue V injected peritumorally. This was followed by standard axillary treatment in the same operation in all patients. Lymphoscintigraphy showed Internal Mammary sentinel Nodes in 62 patients (9%), and Internal Mammary drainage was identified perioperatively in an additional 7 patients (1%) using γ probe detection. Sampling of the Internal Mammary basin, based on the results of lymphoscintigraphy and γ probe detection, was done in 31 of 69 patients (45%). One patient had a pneumothorax and 2 experienced bleeding during Internal Mammary sampling. Internal Mammary metastases were detected in 4 of 31 patients (13%). In 2 of the patients (6%), Internal Mammary Nodes (IMNs) showed metastatic involvement without accompanying axillary metastases. One of these 2 patients would have received adjuvant endocrine systemic therapy because of the characteristics of the tumor, but may not have been recommended to receive adjuvant chemotherapy. Sampling of the Internal Mammary basin led to a change of management in these 2 patients, ie, institution of adjuvant chemotherapy. Therefore, a change in management occurred in only 2 of the 69 patients in our series, but 38 patients with unbiopsied "hot" IMNs remained with unknown Internal Mammary status. Biopsy of IMNs alters staging in few patients, and the impact on indication for adjuvant treatment was low. Internal Mammary SLN biopsy may be associated with some additional morbidity. Current evidence suggests that Internal Mammary SLN biopsy is still a research tool.
Chang Ok Suh - One of the best experts on this subject based on the ideXlab platform.
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Internal Mammary Node Irradiation in Node-Positive Breast Cancer Treated with Mastectomy and Taxane-Based Chemotherapy
2021Co-Authors: Won Kyung Cho, Yong Bae Kim, Jee Suk Chang, Doo Ho Choi, Won Park, Seung Gyu Park, Nalee Kim, Haeyoung Kim, Chang Ok SuhAbstract:Abstract Purpose: It is important to continually reevaluate the risk/benefit calculus of Internal Mammary Node irradiation (IMNI) in the era of modern systemic therapy. We aimed to investigate the effect of IMNI on survival in Node-positive breast cancer treated with mastectomy and anthracycline plus taxane-based chemotherapy.Methods and Materials: We analyzed 348 patients who underwent mastectomy and anthracycline plus taxane-based chemotherapy for Node-positive breast cancer between January 2006 and December 2011. All patients received adjuvant radiotherapy with IMNI (n = 105, 30.2%) or without IMNI (n = 243, 69.8%). The benefit of IMNI for disease-free survival (DFS) and overall survival (OS) was evaluated using multivariate analysis and inverse probability of treatment weighting (IPTW) to adjust for unbalanced covariates between the groups.Results: After a median follow-up of 95 months, the 10-year locoregional recurrence-free survival rate, DFS, and OS in all patients were 94.8%, 77.4%, and 86.2%, respectively. The IPTW-adjusted hazard ratio (HR) for the association of IMNI (vs. no IMNI) with DFS and OS was 0.208 (95% confidence intervals (CI) 0.045–0.966) and 0.460 (95% CI, 0.220-0.962). In multivariate analysis, IMNI was a favorable factor for DFS (HR, 0.458; p = 0.021) and OS (HR 0.233, p = 0.018).Conclusions: IMNI was associated with improved DFS and OS in Node-positive patients treated with mastectomy, post-mastectomy radiation therapy, and taxane-based chemotherapy, although the rate of locoregional recurrence was low.
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does Internal Mammary Node irradiation affect treatment outcome in clinical stage ii iii breast cancer patients receiving neoadjuv ant chemotherapy
Breast Cancer Research and Treatment, 2015Co-Authors: Kyung Hwan Kim, Yong Bae Kim, Jae Myoung Noh, Jee Suk Chang, Ki Chang Keum, Seung Jae Huh, Doo Ho Choi, Won Park, Chang Ok SuhAbstract:The purpose of this study is to assess the value of Internal Mammary Node irradiation (IMNI) in patients receiving postoperative radiotherapy after neoadjuvant chemotherapy (NAC) using modern systemic therapy. Between 2001 and 2009, 521 consecutive patients with clinical stage II–III breast cancer received NAC and postoperative radiotherapy. With a consistent policy, the treating radiation oncologist either included (N = 284) or excluded (N = 237) the Internal Mammary Node in the treatment volume. Anthracycline- and taxane-based chemotherapy was provided to 482 (92.5 %) patients. To account for the unbalanced characteristics between the two groups, we performed propensity score matching and covariate adjustment using the propensity score. The median follow-up duration was 71 months (range 31–153 months). The 5-year disease-free survival (DFS) with and without IMNI was 81.8 and 72.7 %, respectively (p = 0.019). The benefit of IMNI varied according to patient characteristics such that it was more apparent in patients with N1–2 disease, inner/central location, and triple-negative subtype. After adjusting for all potential confounding variables, IMNI was independently associated with improved DFS (p = 0.049). The significant effect of IMNI on DFS was sustained after propensity score matching (p = 0.040) and covariate adjustment using the propensity score (p = 0.048). Symptomatic radiation pneumonitis developed in 9 (3.2 %) patients receiving IMNI. Our results indicated that IMNI was associated with a significant improvement in DFS with low toxicity rate for breast cancer patients receiving NAC. Further prospective studies are warranted to confirm the effect of IMNI in the NAC setting.
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long term survival outcomes following Internal Mammary Node irradiation in stage ii iii breast cancer results of a large retrospective study with 12 year follow up
International Journal of Radiation Oncology Biology Physics, 2013Co-Authors: Jee Suk Chang, Yong Bae Kim, Ki Chang Keum, Doo Ho Choi, Won Park, Chang Ok Suh, Ik Jae Lee, Chang Geol Lee, Seung Jae HuhAbstract:Purpose To examine the effect of Internal Mammary Node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in breast cancer patients treated with modified radical mastectomy and postoperative radiation therapy. Methods and Materials Between 1994 and 2002, 396 patients with stage II-III breast cancer were treated with postmastectomy radiation therapy with (n=197) or without (n=199) IMNI. Patients who received neoadjuvant chemotherapy were excluded. IMNI was administered at the clinical discretion of the treating physician. Median RT dose was 50.4 Gy (range, 45.0-59.4 Gy) in 28 fractions, with inclusion of the supraclavicular fossa in 96% of patients. Adjuvant chemotherapy was administered to 99.7% of the patients and endocrine therapy to 53%. Results The median follow-up was 149 months (range, 124-202). IMNI patients had more advanced nodal stage and non-high grade tumors than those without IMNI ( P P =.05). Multivariate analysis demonstrated that IMNI was an independent, positive predictor of DFS (hazard ratio [HR], 0.70; P =.02). Benefits of IMNI in DFS were seen most apparently in N2 patients (HR, 0.44; 95% confidence interval [CI], 0.26-0.74) and inner/central tumors (HR, 0.55; 95% CI, 0.34-0.90). The 10-year OS with and without IMNI was 72% and 66%, respectively ( P =.62). The 10-year DFS and OS were 61%, and 69%, respectively. Conclusions Internal Mammary Node irradiation significantly improved DFS in postmastectomy breast cancer patients. Pending long-term results from randomized trials, treatment of Internal Mammary Nodes should be considered in postmastectomy radiation therapy.