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Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis

BACKGROUND: A relationship between the axillary-lateral thoracic vessel juncture (ALTJ) dose and lymphedema rate has been reported in patients with breast cancer. The purpose of this study was to validate this relationship and explore whether incorporation of the ALTJ dose-distribution parameters im...

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Autores principales: Suk Chang, Jee, Ko, Heejoo, Hee Im, Sang, Sung Kim, Jin, Kyung Byun, Hwa, Bae Kim, Yong, Jung, Wonguen, Park, Goeun, Sun Lee, Hye, Sung, Wonmo, Olson, Robert, Hong, Chae-Seon, Kim, Kyubo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10149196/
https://www.ncbi.nlm.nih.gov/pubmed/37131951
http://dx.doi.org/10.1016/j.ctro.2023.100629
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author Suk Chang, Jee
Ko, Heejoo
Hee Im, Sang
Sung Kim, Jin
Kyung Byun, Hwa
Bae Kim, Yong
Jung, Wonguen
Park, Goeun
Sun Lee, Hye
Sung, Wonmo
Olson, Robert
Hong, Chae-Seon
Kim, Kyubo
author_facet Suk Chang, Jee
Ko, Heejoo
Hee Im, Sang
Sung Kim, Jin
Kyung Byun, Hwa
Bae Kim, Yong
Jung, Wonguen
Park, Goeun
Sun Lee, Hye
Sung, Wonmo
Olson, Robert
Hong, Chae-Seon
Kim, Kyubo
author_sort Suk Chang, Jee
collection PubMed
description BACKGROUND: A relationship between the axillary-lateral thoracic vessel juncture (ALTJ) dose and lymphedema rate has been reported in patients with breast cancer. The purpose of this study was to validate this relationship and explore whether incorporation of the ALTJ dose-distribution parameters improves the prediction model’s accuracy. METHODS: A total of 1,449 women with breast cancer who were treated with multimodal therapies from two institutions were analyzed. We categorized regional nodal irradiation (RNI) as limited RNI, which excluded level I/II, vs extensive RNI, which included level I/II. The ALTJ was delineated retrospectively, and dosimetric and clinical parameters were analyzed to determine the accuracy of predicting the development of lymphedema. Decision tree and random forest algorithms were used to construct the prediction models of the obtained dataset. We used Harrell’s C-index to assess discrimination. RESULTS: The median follow-up time was 77.3 months, and the 5-year lymphedema rate was 6.8 %. According to the decision tree analysis, the lowest lymphedema rate (5-year, 1.2 %) was observed in patients with ≤ six removed lymph nodes and ≤ 66 % ALTJ V(35Gy). The highest lymphedema rate was observed in patients with > 15 removed lymph nodes and an ALTJ maximum dose (D(max)) of > 53 Gy (5-year, 71.4 %). Patients with > 15 removed lymph nodes and an ALTJ D(max) ≤ 53 Gy had the second highest rate (5-year, 21.5 %). All other patients had relatively minor differences, with a rate of 9.5 % at 5 years. Random forest analysis revealed that the model’s C-index increased from 0.84 to 0.90 if dosimetric parameters were included instead of RNI (P <.001). CONCLUSION: The prognostic value of ALTJ for lymphedema was externally validated. The estimation of lymphedema risk based on individual dose-distribution parameters of the ALTJ seemed more reliable than that based on the conventional RNI field design.
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spelling pubmed-101491962023-05-01 Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis Suk Chang, Jee Ko, Heejoo Hee Im, Sang Sung Kim, Jin Kyung Byun, Hwa Bae Kim, Yong Jung, Wonguen Park, Goeun Sun Lee, Hye Sung, Wonmo Olson, Robert Hong, Chae-Seon Kim, Kyubo Clin Transl Radiat Oncol Original Research Article BACKGROUND: A relationship between the axillary-lateral thoracic vessel juncture (ALTJ) dose and lymphedema rate has been reported in patients with breast cancer. The purpose of this study was to validate this relationship and explore whether incorporation of the ALTJ dose-distribution parameters improves the prediction model’s accuracy. METHODS: A total of 1,449 women with breast cancer who were treated with multimodal therapies from two institutions were analyzed. We categorized regional nodal irradiation (RNI) as limited RNI, which excluded level I/II, vs extensive RNI, which included level I/II. The ALTJ was delineated retrospectively, and dosimetric and clinical parameters were analyzed to determine the accuracy of predicting the development of lymphedema. Decision tree and random forest algorithms were used to construct the prediction models of the obtained dataset. We used Harrell’s C-index to assess discrimination. RESULTS: The median follow-up time was 77.3 months, and the 5-year lymphedema rate was 6.8 %. According to the decision tree analysis, the lowest lymphedema rate (5-year, 1.2 %) was observed in patients with ≤ six removed lymph nodes and ≤ 66 % ALTJ V(35Gy). The highest lymphedema rate was observed in patients with > 15 removed lymph nodes and an ALTJ maximum dose (D(max)) of > 53 Gy (5-year, 71.4 %). Patients with > 15 removed lymph nodes and an ALTJ D(max) ≤ 53 Gy had the second highest rate (5-year, 21.5 %). All other patients had relatively minor differences, with a rate of 9.5 % at 5 years. Random forest analysis revealed that the model’s C-index increased from 0.84 to 0.90 if dosimetric parameters were included instead of RNI (P <.001). CONCLUSION: The prognostic value of ALTJ for lymphedema was externally validated. The estimation of lymphedema risk based on individual dose-distribution parameters of the ALTJ seemed more reliable than that based on the conventional RNI field design. Elsevier 2023-04-20 /pmc/articles/PMC10149196/ /pubmed/37131951 http://dx.doi.org/10.1016/j.ctro.2023.100629 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research Article
Suk Chang, Jee
Ko, Heejoo
Hee Im, Sang
Sung Kim, Jin
Kyung Byun, Hwa
Bae Kim, Yong
Jung, Wonguen
Park, Goeun
Sun Lee, Hye
Sung, Wonmo
Olson, Robert
Hong, Chae-Seon
Kim, Kyubo
Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis
title Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis
title_full Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis
title_fullStr Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis
title_full_unstemmed Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis
title_short Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis
title_sort incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: a validation analysis
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10149196/
https://www.ncbi.nlm.nih.gov/pubmed/37131951
http://dx.doi.org/10.1016/j.ctro.2023.100629
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