Skip to main content

Table 4 Review of the literature reporting boundaries of and dose to axillary Level I volumes and/or clips in patients undergoing tangential radiation therapy as part of breast conservation therapy

From: Axillary lymph node dose with tangential whole breast radiation in the prone versus supine position: a dosimetric study

Study

Patients (n)

Method

Axillary surgery

Axillary clips (n)

Borders of axillary Level I

Dose to Level I

Krasin et al.[3]

25

2D sim/3D analysis

ALND*

16

Not listed

Mean dose = 32 Gy (63.5%)

Aristei et al.[4]

35

2D sim/3D analysis

ALND

35

Caudal border: Inferior clip

D90% = 6.75 Gy

     

Cranial border: Axillary vein and 2nd clip

 
     

Medial border: Lateral border of pectoralis minor

 
     

Lateral border: Axillary vein

 
     

Posterior border: Latissimus dorsi

 

Takeda et al.[5]

44

2D sim/3D analysis

ALND

44

Caudal border: Clip in latissimus dorsi at inferior level of dissection

Median V80% = 30.5%

     

Cranial border: Clip in the latissimus dorsi at level of axillary vein

 
     

Posterior border: Clip in adjacent to subscapularis vein

 

Orecchia et al.[6]

15

3D CRT

SNB††

15

Caudal border: SNB clip

Mean dose = 48.7%

     

Cranial border Manubrium

± 22%

 

35

3D CRT

SNB

N/A

Caudal border: Between 4th and 5th ribs

V95% = 51% ± 16%

Reznik et al.[7]

    

Cranial border: Axillary vein

Mean dose = 66% ± 13%

     

Medial border: Pectoralis minor

 

Reed et al.[8]

50

3D CRT

32 SNB

50

Caudal border: Latissiumus dorsi and clavipectoral-lattisimus fascia

Mean V95% = 55% Median V95% = 53%

   

18 ALND

 

Cranial border: Most inferior axial image of axillary artery/vein

 
     

Medial border: Pectoralis minor

 
     

Lateral border: Medial aspect of pectoralis seratus

 
     

Anterior border: Pectoralis minor

 
     

Posterior border: Latissimus dorsi and subscapularis

 

Alonso-Basanta et al.[9]

20

3D CRT

Not reported

N/A

Caudal border: Origin of pectoralis minor 3rd – 5th ribs

V95% < 60%

     

Cranial border: Pectoralis minor insertion of the coracoid process

Prone: Mean dose = 11.2 Gy

     

Medial border: Pectoralis minor

Supine: Mean dose = 21 Gy

     

Lateral border: Latissimus dorsi

 
     

Posterior border: Latissimus dorsi

 

Schlembach et al.[10]

105

3D CRT

65 SNB

105

Surgical clips

85% of clips in the field

      

Mean dose to clips = 98%

   

39 ALND

   

McCormick et al.[11]

45

2D

ALND

45

Surgical clips

38% of clips in field

Chung et al.[12]

36

2D or 3D CRT

SNB

36

Surgical clips

94% of clips in field

Present study

46

3D CRT

SNB

7 prone

RTOG Atlas [20]

Prone: V95% = 14%

    

9 supine

 

Mean dose = 36% ± 31%

      

Mean dose to clips = 43%

      

Supine: V95% = 37% (supine)

      

Mean dose = 66% ± 20%

      

Mean dose to clips = 95%

  1. *ALND = Axillary lymph node dissection; 3DCRT = Three dimensional conformal radiation therapy; ††SNB = Sentinel node biopsy.