Purpose

To evaluate the incidence of symptoms related to brachial plexus neuropathy (BPN) and the dose distribution to the brachial plexus (BP) in patients with breast cancertreated with supraclavicular (SCV) irradiation and boost.

Methods and Materials

In this study, 117 patients with initial ipsilateral supraclavicular lymph node (SLN) metastasis and 39 with recurrent SLN metastasis between 2008 and 2018 in our cancer center were retrospectively analyzed. All patients were treated with 50 Gy of SCV irradiation in 25 fractions and a boost (median dose, 10 Gy; range, 10-16 Gy) to involved nodes in the SCV area. Symptoms related to BPN (including ipsilateral arm numbness, pain, and weakness) were recorded and graded according to the Common Terminology Criteria for Adverse Events, version 5.0. The BP was delineated on simulation computed tomography, and the dose distributions to the BP were evaluated. Meanwhile, 297 patients treated with SCV irradiation without boost during the same period were identified as a control group to compare the incidences of BPN-related symptoms and dosimetric data with patients who received an SCV boost.

Results

The 5-year overall survival rate was 80.3% for patients with initial SLN metastasis and 51.0% for patients with recurrent SLN metastasis. For patients who received an SCV boost, incidence rates of ipsilateral arm numbness, pain, and weakness were 23.9%, 18.3%, and 34.3%, respectively. Four patients (5.6%) developed grade 2 numbness and 3 (4.3%) developed grade 2 arm weakness. In the control group, incidence rates of arm numbness, pain, and weakness were 31.6%, 21.9%, and 36.0%, respectively. The incidence of BPN-related symptoms was not significantly different between the 2 groups. Symptoms of grade 3 were not observed in either cohort. The mean doses to the BP in patients who received boost and who did not were 56.8 and 46.8 Gy, respectively (P < .001). The maximum doses to the BP in patients who received boost and who did not were 64.5 and 53.5 Gy, respectively (P < .001). The BP volumes receiving at least 50 Gy, 60 Gy, 61 Gy, and 62 Gy were also significantly higher in the boosted group compared with the control group (P < .001).

Conclusions

This study found that an SCV boost of 10 Gy did not increase the incidence of BPN-related symptoms and that the toxicity to the BP was acceptable. Comprehensive treatment including SCV irradiation and boost led to satisfactory survival outcomes in patients with breast cancer who had SLN metastasis.

中文翻译：

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锁骨上照射后与臂丛神经病变相关的症状和乳腺癌的增加

目的

评估接受锁骨上 (SCV) 照射和加强治疗的乳腺癌患者臂丛神经病变 (BPN) 相关症状的发生率和臂丛神经 (BP) 的剂量分布。

方法和材料

在这项研究中，回顾性分析了我们癌症中心 2008 年至 2018 年间 117 例初始同侧锁骨上淋巴结（SLN）转移和 39 例复发 SLN 转移的患者。所有患者均接受 25 次 50 Gy 的 SCV 照射，并对 SCV 区域的受累淋巴结进行加强（中位剂量，10 Gy；范围，10-16 Gy）。记录与 BPN 相关的症状（包括同侧手臂麻木、疼痛和虚弱）并根据不良事件通用术语标准 5.0 版进行分级。在模拟计算机断层扫描上描绘了 BP，并评估了 BP 的剂量分布。同时，

结果

初始 SLN 转移患者的 5 年总生存率为 80.3%，复发 SLN 转移患者的 51.0%。对于接受 SCV 加强的患者，同侧手臂麻木、疼痛和无力的发生率分别为 23.9%、18.3% 和 34.3%。4 名患者 (5.6%) 出现 2 级麻木，3 名患者 (4.3%) 出现 2 级手臂无力。对照组手臂麻木、疼痛和无力的发生率分别为31.6%、21.9%和36.0%。BPN相关症状的发生率在2组之间没有显着差异。两组均未观察到 3 级症状。接受和未接受加强的患者的 BP 平均剂量分别为 56.8 和 46.8 Gy（P< .001)。接受和未接受加强的患者的最大血压剂量分别为 64.5 和 53.5 Gy ( P < .001)。与对照组相比，加强组接受至少 50 Gy、60 Gy、61 Gy 和 62 Gy 的 BP 体积也显着增加（P < .001）。

结论

该研究发现，SCV 加强 10 Gy 不会增加 BPN 相关症状的发生率，并且对 BP 的毒性是可以接受的。包括 SCV 照射和加强在内的综合治疗为患有 SLN 转移的乳腺癌患者带来了令人满意的生存结果。