Internal mammary nodes radiation – pro
There exists the controversy about internal mammary radiation. Multiple studies consistently show that a significant minority of patients with breast cancer have pathologic IMN involvement, and the risk of IMN involvement increases in patients with medial tumors and/or positive axillary nodes. Some recommend lymphoscintigraphy to identify such patients. While it seems reasonable based on these data to consider IMN irradiation for patients with medial tumors and/or positive axillary nodes, evidence directly linking IMN treatment to a survival benefit is not currently available. Randomized trials evaluating IMN dissection did not show a survival benefit, although they were largely underpowered, and retrospective studies evaluating patients with versus without IMN treatment have shown mixed results.
Russell NS, Kunkler IH, van Tienhoven G, Canney PA, Thomas J, Bartlett J, van de Vijver MJ, Belkacemi Y, Yarnold JR, Barrett-Lee PJ.Postmastectomy radiotherapy: will the selective use of postmastectomy radiotherapy study end the debate?J Clin Oncol. 2009 Feb 20;27(6):996-7; author reply 997-8. Epub 2009 Jan 21.
P. T. Truong, I. A. Olivotto, T. J. Whelan, and M. Levine
Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy
Can. Med. Assoc. J., April 13, 2004; 170(8): 1263 – 1273.
Recht, Abram, Edge, Stephen B., Solin, Lawrence J., Robinson, David S., Estabrook, Alison, Fine, Richard E., Fleming, Gini F., Formenti, Silvia, Hudis, Clifford, Kirshner, Jeffrey J., Krause, David A., Kuske, Robert R., Langer, Amy S., Sledge, George W., Jr, Whelan, Timothy J., Pfister, David G.
Postmastectomy Radiotherapy: Clinical Practice Guidelines of the American Society of Clinical Oncology
J Clin Oncol 2001 19: 1539-1569