ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer

Offersen, Birgitte Vrou; Boersma, Liesbeth; Kirkove, Carine; Hol, S.; Aznar, Marianne C.; Solá, Albert Biete; Kirova, Youlia; Pignol, Jean-Philippe; Remouchamps, Vincent; Verhoeven, K.; Weltens, Caroline; Arenas, Meritxell; Gabryś, Dorota; Kopek, Neil; Krause, Mechthild; Lundstedt, Dan; Marinko, Tanja; Montero, Á.; Yarnold, John; Poortmans, Philip

doi:10.1016/j.radonc.2014.11.030

Cited by 524 publications

(369 citation statements)

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“…30,31 The interaction among prognostic factors, the use of systemic therapy, and the benefit of improving regional control has been described previously. 32 The benefit of regional-node irradiation was also seen in patients with medially or centrally located primary tumors without axillary nodal involvement.…”

Section: Discussionmentioning

confidence: 93%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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BACKGROUND The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. METHODS We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracicwall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer. RESULTS Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median followup of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest. CONCLUSIONS In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.).

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Section: Discussionmentioning

confidence: 93%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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“…The European Society for Radiotherapy and Oncology (ESTRO) consensus guidelines on target delineation for whole breast (WB) radiotherapy state the target should include all glandular breast tissue [7], however, the extent of glandular breast tissue is not clear on CT scans [8]. Magnetic resonance imaging (MRI) has been shown to better identify breast tumours and allow greater distinction between glandular breast tissue and adipose tissue when compared with CT [6,9].…”

Section: Introductionmentioning

confidence: 99%

The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning

Dundas

Pogson

Batumalai

et al. 2018

Practical Radiation Oncology

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The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiotherapy planning, Practical Radiation Oncology (2017Oncology ( ), doi: 10.1016Oncology ( /j.prro.2017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT Title:The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiotherapy planning. Short Title:CT/MRI Supine/Prone Breast RadiotherapyAuthor Details: Conflict of Interest Statement:The authors report a grant (no. APP1033237) from Cancer Australia and the National Breast Cancer Foundation during the conduct of this study. Dr. Pogson reports grants from University of Wollongong, during the conduct of the study.Word Count: 3642 A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT Abstract:Purpose: To evaluate the impact of MRI vs CT derived planning target volumes (PTVs), in both supine and prone positions, for whole breast (WB) radiotherapy. Methods and Materials:Four WB radiotherapy plans were generated for 28 patients, where PTVs were generated based on CT or MRI data alone in both supine and prone positions. A 6MV tangential IMRT technique was used, with plans designated as ideal, acceptable or non-compliant. Dose metrics for PTVs and OARs were compared to analyse any differences based on imaging modality (CT vs MRI) or patient position (supine vs prone).Results: With respect to imaging modality 2/11 WB_PTV dose metrics (V90% and V110%) displayed statistically significant differences, however these differences did not alter the average plan compliance rank. With respect to patient positioning, the odds of having an ideal plan vs a non-compliant plan were higher for the supine position compared to the prone position (p=0.026). The minimum distance between the seroma cavity (SC)_PTV and the chest-wall was increased with prone positioning, (p<0.001, supine and prone values 1.1 mm and 8.7 mm respectively). Heart volume was greater in the supine position (p=0.005). Heart doses were lower in the supine position than prone (p<0.01, mean doses 3.4 ± 1.55 Gy vs 4.4 ± 1.13 Gy for supine vs prone respectively). Mean lung doses met ideal dose constraints in both positions, however best spared in the prone position. The contra-lateral breast D1cc showed significantly lower doses in the supine position, (p<0.001, 4.64 Gy vs 9.51 Gy). Conclusions:Planning with PTVs generated from MRI data showed no clinically significant differences to planning with PTVs generated from CT with respect to PTV and OAR doses. Prone positioning within this study r...

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“…This trial is using the 2015-published ESTRO guidelines for definition of the nodal volumes. 12 We have adopted these guidelines entirely in our departmental nodal-outlining policy. The practice of nodal radiotherapy for early breast cancer is increasing in many centres.…”

Section: Discussionmentioning

confidence: 99%