Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Internal mammary node irradiation in early breast cancer – target coverage and implications on dose to organs at risk

Berg, Lovisa LU ; Sporre, Jeanette LU ; Kjellén, Elisabeth LU ; Ceberg, Sofie LU ; Wieslander, Elinore LU and Alkner, Sara LU (2025) In Acta Oncologica 64. p.989-996
Abstract

Purpose: Indications for radiotherapy (RT) of the internal mammary nodes (IMN) in early breast cancer vary between countries. While studies indicate benefits, IMN RT increases the dose to the heart and lungs, and the risk-benefit ratio of this treatment is debated. This study investigates how IMN RT affects dose to organs at risk (OAR) and pneumonitis incidence in a clinical setting. Methods: This retrospective study includes breast cancer patients receiving adjuvant locoregional RT with and without IMN included in the target volume at Skåne University Hospital, Sweden, from 2018 to 2021. Treatment plans followed national dose-volume criteria, prioritizing lung and heart over IMN coverage. A total of 247 treatment plans for locoregional... (More)

Purpose: Indications for radiotherapy (RT) of the internal mammary nodes (IMN) in early breast cancer vary between countries. While studies indicate benefits, IMN RT increases the dose to the heart and lungs, and the risk-benefit ratio of this treatment is debated. This study investigates how IMN RT affects dose to organs at risk (OAR) and pneumonitis incidence in a clinical setting. Methods: This retrospective study includes breast cancer patients receiving adjuvant locoregional RT with and without IMN included in the target volume at Skåne University Hospital, Sweden, from 2018 to 2021. Treatment plans followed national dose-volume criteria, prioritizing lung and heart over IMN coverage. A total of 247 treatment plans for locoregional RT with IMN were compared to 397 without. Dose to OAR, IMN coverage and pneumonitis incidence were investigated. Results: The mean ipsilateral lung dose increased by 2.7 Gy with IMN RT (p < 0.001), and the mean heart dose (left-sided treatment) by 0.5 Gy (p < 0.001). Both irradiated and treated volume in relation to planning target volume (PTV) increased with ~20% (p < 0.001). Desired IMN coverage was achieved in 76% of the plans, with lung dose exceeding recommended constraints as the primary reason for decreased target coverage in the remaining plans. Of the 220 patients with follow-up of ≥6 months, 2 (0.9%) were diagnosed with pneumonitis grade 2. Interpretation: Introduction of IMN RT primarily resulted in an increased lung dose. However, rate of symptomatic pneumonitis was low. Most patients achieved desired IMN coverage using 3D-CRT, with lung dose being the limiting factor.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adjuvant radiotherapy, Breast cancer, internal mammary nodes, treatment planning
in
Acta Oncologica
volume
64
pages
8 pages
publisher
Taylor & Francis
external identifiers
  • pmid:40734573
  • scopus:105012649354
ISSN
0284-186X
DOI
10.2340/1651-226X.2025.43716
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s).
id
575811c0-f3c3-440d-b84b-398ed588ff92
date added to LUP
2025-12-22 10:26:31
date last changed
2025-12-22 10:27:32
@article{575811c0-f3c3-440d-b84b-398ed588ff92,
  abstract     = {{<p>Purpose: Indications for radiotherapy (RT) of the internal mammary nodes (IMN) in early breast cancer vary between countries. While studies indicate benefits, IMN RT increases the dose to the heart and lungs, and the risk-benefit ratio of this treatment is debated. This study investigates how IMN RT affects dose to organs at risk (OAR) and pneumonitis incidence in a clinical setting. Methods: This retrospective study includes breast cancer patients receiving adjuvant locoregional RT with and without IMN included in the target volume at Skåne University Hospital, Sweden, from 2018 to 2021. Treatment plans followed national dose-volume criteria, prioritizing lung and heart over IMN coverage. A total of 247 treatment plans for locoregional RT with IMN were compared to 397 without. Dose to OAR, IMN coverage and pneumonitis incidence were investigated. Results: The mean ipsilateral lung dose increased by 2.7 Gy with IMN RT (p &lt; 0.001), and the mean heart dose (left-sided treatment) by 0.5 Gy (p &lt; 0.001). Both irradiated and treated volume in relation to planning target volume (PTV) increased with ~20% (p &lt; 0.001). Desired IMN coverage was achieved in 76% of the plans, with lung dose exceeding recommended constraints as the primary reason for decreased target coverage in the remaining plans. Of the 220 patients with follow-up of ≥6 months, 2 (0.9%) were diagnosed with pneumonitis grade 2. Interpretation: Introduction of IMN RT primarily resulted in an increased lung dose. However, rate of symptomatic pneumonitis was low. Most patients achieved desired IMN coverage using 3D-CRT, with lung dose being the limiting factor.</p>}},
  author       = {{Berg, Lovisa and Sporre, Jeanette and Kjellén, Elisabeth and Ceberg, Sofie and Wieslander, Elinore and Alkner, Sara}},
  issn         = {{0284-186X}},
  keywords     = {{adjuvant radiotherapy; Breast cancer; internal mammary nodes; treatment planning}},
  language     = {{eng}},
  pages        = {{989--996}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Oncologica}},
  title        = {{Internal mammary node irradiation in early breast cancer – target coverage and implications on dose to organs at risk}},
  url          = {{http://dx.doi.org/10.2340/1651-226X.2025.43716}},
  doi          = {{10.2340/1651-226X.2025.43716}},
  volume       = {{64}},
  year         = {{2025}},
}