Assessment of Risk Reduction for Lymphedema Following Sentinel Lymph Noded Guided Surgery for Primary Breast Cancer

摘要

Lymphedema is a common complication of primary breast cancer therapy. It is a chronic, insidiously progressive, and potentially devastating condition. Radiation increases patients lymphedema risk as conventional fields encompass functioning lymphatics. Imaging technologies may identify these lymphatics and allow tailoring of radiation fields to minimize radiation exposure while preserving regional tumor control. This study uses SPECT scanning to localize lymphatics critical for arm drainage after surgical removal of axillary lymph nodes. The study has established the feasibility of fusing SPECT images with high resolution CT scans used in radiation simulation. Furthermore the study has demonstrate that fusing allows precise quantification of radiation dosimetry delivered to lymph nodes critical for arm drainage. The study will test the hypothesis that increased arm volume correlates with high levels of radiation dosimetry. The fact that higher doses of radiation and larger radiation ports are associated with an increased incidence of lymphedema (volume > 150ml.), particularly severe lymphedema (volume > 400ml.), supports this hypothesis. The proposed study realizes the BCRP goals by elucidating a novel means of refining breast cancer treatment to minimize patients' risk of developing the most prevalent and dreaded complication of conventional therapy, lymphedema.