| Objective : We count and analyze the recurrence of regional lymph nodes after breast cancer surgery,and discuss whether the target area of postoperative radiotherapy for breast cancer patients is enough.In order to provide accurate and suitable individualized radiotherapy scheme for breast cancer patients with different clinical and pathological characteristics in the future.Method: We Reviewed the breast cancer patients admitted to Guilin Medical College Affiliated Hospital and Second Affiliated Hospital Hospital from January 2013 to June 2022,and Collected the clinical data of 103 patients with regional lymph node recurrence after breast cancer surgery confirmed by pathology or PET-CT,including age,TNM stage,tumor primary site,recurrence site,molecular typing,etc.The data were analyzed by SPSS25.0 software,and the comparison between groups was performed by Chi square test or Fisher exact probability method;The di fference was considered statistically significant(P<0.05).According to the adjacent relationship between the recurrence site and the obvious anatomic al structure,the spatial relationship between the recurrence site of the regional lymph node and the rad iotherapy target area is depicted in the Varian Eclipse planning system.Results:103 patients with regional lymph node recurrence who were confirmed by pathology or PET-CT were selected from5631 patients with breast cancer,Among them,129 subareas have recurrence(some patients have multiple regional recurrence).Among the recurrence sites,there are 7 axillary lymph nodes in station I(6.9%),36 axillary lymph nodes in station II(including pectoral intermuscular lymph nodes)(27.8%),10 axillary lymph nodes in station III(subclavian lymph nodes)(7.8%),and 67 supraclavicul ar lymph nodes are the most frequently affected areas(51.9%),(38 lymph node s in the medial supraclavicular group and 29 lymph nodes in the lateral supraclavicular group),and 7 lymph nodes in the inner breast region(5.4%);The risk of involvement in the supraclavicular lymph node region and the axillary lymph node region(including the pectoral intermuscular lymph nodes)at station II was significantly higher than that at other sites(P<0.05);There were 29 cases(28.2%)of recurrence in the lateral supraclavicular lymph node group,including N0-1patients(n=7,6.7%),N2-3 patients(n=22,21.4%),T1-2 patients(n=14,13.6%),and T3-4 patients(n=15,14.6%).There was statistical difference in N stage in patients with posterior lateral supraclavicular lymph nodes(P<0.05),and no statistical difference in T stage(P=0.148);In 7 patients with recurrent breast cancer,the primary tumor focus was located in the medial quadrant(n=5,4.8%),the lateral quadrant(n=2,1.9%),the ER(+)patients(n=2,1.9%),and the ER(-)patients(n=5,4.8%).There was a statistically significant differen ce in the risk of recurrent breast cancer between the primary site and the ER status(P<0.05).Conclusions :(1)In this study,among patients with postoperative recurrence of breast cancer,the rec urrence probability of supraclavicular lymph nodes is the hig hest,and some of them are located in the supraclavicular lateral area(treatment field).For patients wi th higher N stage(N2-3),the target area of supraclavicular lymph nodes can be appropriat ely expanded posterolateral.(2)The recurrence rate of axillary lymph nodes in group II is relatively high.Considering that there may be areas that are not covered by surgery and radiotherapy,it may be considered to place marker points at the border of axillary lymph node dissection for this area.After defining the scope of surgery,the uncleaned axillary lymph node drainage area shall be included in the radiotherapy target area.(3)The recurrence rate of the drainage area of the internal mammary lymph node is low,and it is not suitable to routinely use it as a treatment target area.If there are high-risk factors such as the tumor located in the medial quadrant,ER(-),and so on.".The internal mammary lymph node region may be considered as a target area for radiotherapy. |
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