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J Korean Soc Ther Radiol Oncol > Volume 25(1); 2007 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2007;25(1): 7-15.
The 1998, 1999 Patterns of Care Study for Breast Irradiation after Mastectomy in Korea
Ki Chang Keum, Su Jung Shim, Ik Jae Lee, Won Park, Sang wook Lee, Hyun Soo Shin, Eun Ji Chung, Eui Kyu Chie, Il Han Kim, Do Hoon Oh, Sung Whan Ha, Hyung Sik Lee, Sung Ja Ahn, Moon June Cho, Juhn Kyu Loh, Kyung Ran Park, Doo Ho Choi, Myung Za Lee, Ki Jung Ahn, Won Dong Kim, Bo Kyoung Kim, Mison Chun, Jin Hee Kim, Chang Ok Suh
1Yonsei University College of Medicine, Korea. cosuh317@yumc.yonsei.ac.kr
2Sungkyunkwan University Samsung Medical Center, Korea.
3University of Ulsan Medical College, Korea.
4Pochon CHA University College of Medicine, Korea.
5National Health Insurance Corporation Ilsan Hospital, Korea.
6Seoul National University College of Medicine, Korea.
7Dong-A University College of Medicine, Korea.
8Chonnam National University College of Medicine, Korea.
9Chungnam National University College of Medicine, Korea.
10Inha University College of Medicine, Korea.
11Hanyang University College of Medicine, Korea.
12Inje University Pusan Paik Hospital, Korea.
13Yonsei University Wonju College of Medicine, Korea.
14Soonchunhyang University College of Medicine, Korea.
15Chungbuk National University Hospital, Korea.
16Dankook University College of Medicine, Korea.
17Ajou University College of Medicine, Korea.
18Keimyung University College of Medicine, Korea.
ABSTRACT
PURPOSE:
To determine the patterns of evaluation and treatment in patients with breast cancer after mastectomy and treated with radiotherapy. A nationwide study was performed with the goal of improving radiotherapy treatment.
MATERIALS AND METHODS:
A web-based database system for the Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Randomly selected records of 286 eligible patients treated between 1998 and 1999 from 17 hospitals were reviewed.
RESULTS:
The ages of the study patients ranged from 20 to 80 years (median age 44 years). The pathologic T stage by the AJCC was T1 in 9.7% of the cases, T2 in 59.2% of the cases, T3 in 25.6% of the cases, and T4 in 5.3% of the cases. For analysis of nodal involvement, N0 was 7.3%, N1 was 14%, N2 was 38.8%, and N3 was 38.5% of the cases. The AJCC stage was stage I in 0.7% of the cases, stage IIa in 3.8% of the cases, stage IIb in 9.8% of the cases, stage IIIa in 43% of the cases, stage IIIb in 2.8% of the cases, and IIIc in 38.5% of the cases. There were various sequences of chemotherapy and radiotherapy after mastectomy. Mastectomy and chemotherapy followed by radiotherapy was the most commonly performed sequence in 47% of the cases. Mastectomy, chemotherapy, and radiotherapy followed by additional chemotherapy was performed in 35% of the cases, and neoadjuvant chemoradiotherapy was performed in 12.5% of the cases. The radiotherapy volume was chest wall only in 5.6% of the cases. The volume was chest wall and supraclavicular fossa (SCL) in 20.3% of the cases; chest wall, SCL and internal mammary lymph node (IMN) in 27.6% of the cases; chest wall, SCL and posterior axillary lymph node in 25.9% of the cases; chest wall, SCL, IMN, and posterior axillary lymph node in 19.9% of the cases. Two patients received IMN only. The method of chest wall irradiation was tangential field in 57.3% of the cases and electron beam in 42% of the cases. A bolus for the chest wall was used in 54.8% of the tangential field cases and 52.5% of the electron beam cases. The radiation dose to the chest wall was 45~59.4 Gy (median 50.4 Gy), to the SCL was 45~59.4 Gy (median 50.4 Gy), and to the PAB was 4.8~38.8 Gy, (median 9 Gy)
CONCLUSION:
Different and various treatment methods were used for radiotherapy of the breast cancer patients after mastectomy in each hospital. Most of treatment methods varied in the irradiation of the chest wall. A separate analysis for the details of radiotherapy planning also needs to be followed and the outcome of treatment is needed in order to evaluate the different processes.
Key Words: Breast cancer, Radical mastectomy, Radiotherapy
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