8.1.5 Radiotherapy for Locally Advanced Breast Can...
Local staged breast cancer refers to the tumor burden in the breast and regional lymphatic drainage area，but there is no distant organ metastasis，mostly in the clinical stage Ⅲ，ie T3（breast tumor＞5cm）with lymph node metastasis，T lesion，or N2，N3 lesions.Clinical manifestations include breast skin ulcers，edema，satellite nodules，tumor invasion of the chest wall，axillary lymph node fusion，internal mammary lymph node metastasis，supraclavicular and inferior lymph node metastasis.
The scope of postoperative radiotherapy for modified radical mastectomy was mainly in the chest wall and the upper and lower lymphatic drainage areas of the clavicle.The dose segmentation method was the same as the radiotherapy after radical mastectomy in early stage.For patients with supraclavicular or internal mammary lymph node metastasis at the time of initial diagnosis，the upper supraclavicular region or the inner breast region（between 1 and 3 intercostal spaces）should be irradiated with 45-50 Gy，and the original supraclavicular or internal mammary lymph node metastasis should be irradiated.If the supraclavicular or internal mammary lymph nodes disappear after chemotherapy，add 10Gy/5f；if the supraclavicular or internal mammary lymph nodes remain after chemotherapy，add 16～20Gy/8-10F.In order to reduce radiotherapy damage，try to avoid total lymph node area irradiation，which requires the patient to carry out CT examination of the corresponding site at the time of initial diagnosis，to identify the initial lymph node metastasis，to provide reference for radiotherapy to determine the supplementary irradiation range，to prevent lymph node disappear completely after chemotherapy.It is not possible to accurately locate the replenishment range.At the same time，it is emphasized that the lymphatic drainage area should be carefully evaluated at the time of initial diagnosis，and the swollen suspicious metastatic lymph nodes should be puncture for tissue examination to avoid missed diagnosis and insufficient dose of radiotherapy.(https://www.daowen.com)
In patients with locally advanced breast cancer who are unable to undergo surgery after neoadjuvant chemotherapy，preoperative radiotherapy or radical radiotherapy may be performed.The preoperative radiotherapy dose was 50Gy，and the probability of complications was increased.At the time of radical radiotherapy，the total breast dose was 50 Gy，and then the residual lesion was irradiated with additional dose.According to the size of the residual lesion，the additional dose was 10-20 Gy.The dose in the lymphatic drainage area is 45～50y/4.5～5 weeks，then 10～20Gy is added to the enlarged lymph nodes.The skin and subcutaneous areas of locally advanced breast cancer are highly likely to be invaded by tumors.The amount of radiation in the skin and subcutaneous areas should be increased during radiotherapy.It can be solved by adding fillers daily or every other day.Due to the high dose of skin irradiation，wet skin reactions usually occur during radiotherapy，and radiotherapy can be temporarily interrupted.After 1-2 weeks of rest，additional doses of residual lesions are applied.