Vessel based delineation guidelines for the elective lymph node regions in breast cancer radiation therapy – PROCAB guidelines

Verhoeven, K.; Weltens, Caroline; Remouchamps, Vincent; Mahjoubi, K.; Veldeman, Liv; Lengelé, Benoît; Hortobagyi, E.; Kirkove, Carine

doi:10.1016/j.radonc.2014.11.008

Cited by 46 publications

(27 citation statements)

References 11 publications

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“…To compensate for the expected difficulty in accurately pinpointing the location of the lymphatic system during treatment planning, several delineation guidelines (that will be discussed in more detail later) were developed as a template for a uniform treatment planning for patients worldwide. These guidelines are based on anatomical landmarks and they include a certain margin for the location of the lymphatic system to compensate for the uncertainty of its location, to make sure all lymphatic targets are incorporated (White et al n.d.;Martinez-Monge et al 1999;Kiricuta et al 2000;Madu et al 2001;Dijkema et al 2004;Kirova et al 2010;Atean et al 2013;Nielsen et al 2013;Verhoeven et al 2015;Offersen et al 2016;Jethwa et al 2017). This margin leads to more healthy tissue/organ at risk damage, however, increasing the chance of radiotherapy induced side effects.…”

Section: Introduction To Radiotherapymentioning

confidence: 99%

Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research

Stouthandel

Veldeman

Hoof

2019

The Anatomical Record

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This review intends to rekindle efforts to map the lymphatic system by using a more modern approach, based on medical imaging. The structure, function, and pathologies associated with the lymphatic system are first discussed to highlight the need for more accurately mapping the lymphatic system. Next, the need for an interdisciplinary approach, with a central role for the anatomist, to come up with better maps of the lymphatic system is emphasized. The current approaches on lymphatic system research involving medical imaging will be discussed and suggestions will be made for an all‐encompassing effort to thoroughly map the entire lymphatic system. A first‐hand account of our integration as anatomists in the radiotherapy department is given as an example of interdisciplinary collaboration. From this account, it will become clear that the interdisciplinary collaboration of anatomists in the clinical disciplines involved in lymphatic system research/treatment still holds great promise in terms of improving clinical regimens that are currently being employed. As such, we hope that our fellow anatomists will join us in an interdisciplinary effort to map the lymphatic system, because this could, in a relatively short timeframe, provide improved treatment options for patients with cancer or lymphatic pathologies all over the world. Anat Rec, 302:1681–1695, 2019. © 2019 American Association for Anatomy

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Section: Introduction To Radiotherapymentioning

confidence: 99%

Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research

Stouthandel

Veldeman

Hoof

2019

The Anatomical Record

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“…Volumes of respective axillary levels (I-IV) are given, delineated on MRI according to modified ESTRO delineation guidelines (Offersen et al 2015). et al 2013, Offersen et al 2013, Gentile et al 2015, Verhoeven et al 2015. One could therefore argue that LNs outside the elective axillary levels are not clinically relevant.…”

Section: Discussionmentioning

confidence: 99%

Supine MRI for regional breast radiotherapy: imaging axillary lymph nodes before and after sentinel-node biopsy

et al. 2017

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Regional radiotherapy (RT) is increasingly used in breast cancer treatment. Conventionally, computed tomography (CT) is performed for RT planning. Lymph node (LN) target levels are delineated according to anatomical boundaries. Magnetic resonance imaging (MRI) could enable individual LN delineation. The purpose was to evaluate the applicability of MRI for LN detection in supine treatment position, before and after sentinel-node biopsy (SNB). Twenty-three female breast cancer patients (cTis-3N0M0) underwent 1.5 T MRI, before and after SNB, in addition to CT. Endurance for MRI was monitored. Axillary levels were delineated. LNs were identified and delineated Institute of Physics and Engineering in MedicineOriginal content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI. on MRI from before and after SNB, and on CT, and compared by Wilcoxon signed-rank tests. LN locations and LN-based volumes were related to axillary delineations and associated volumes. Although postoperative effects were visible, LN numbers on postoperative MRI (median 26 LNs) were highly reproducible compared to preoperative MRI when adding excised sentinel nodes, and higher than on CT (median 11, p < 0.001). LN-based volumes were considerably smaller than respective axillary levels. Supine MRI of LNs is feasible and reproducible before and after SNB. This may lead to more accurate RT target definition compared to CT, with potentially lower toxicity. With the MRI techniques described here, initiation of novel MRI-guided RT strategies aiming at individual LNs could be possible.

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“…3-D treatment planning is mandatory, and several anatomically based instruction guidelines have been published to define individual contouring of the different LN regions [33,34,35]. …”

Section: Targeting Technique and Dose For Rnimentioning

confidence: 99%

Radiotherapy of the Lymphatic Pathways in Early Breast Cancer

Sautter-Bihl

Sedlmayer

2015

Breast Care

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International guidelines reveal substantial differences regarding indications for regional nodal irradiation (RNI). Recently, several randomized studies provided new insights and these are discussed here. Patients with 1-3 positive nodes seem to profit from RNI compared to whole-breast (WBI) or chest-wall irradiation (CWI) alone, both with regard to locoregional control and disease-free survival. Irradiation of the regional lymphatics including axillary, supraclavicular and internal mammary nodes provided a small but significant survival benefit in recent randomized trials and 1 meta-analysis. Lymph node irradiation yields comparable tumor control in comparison to axillary lymph node dissection while reducing the rate of lymph edema. Data concerning the impact of 1-2 macroscopically affected sentinel nodes or microscopic metastases on prognosis are equivocal. Recent data suggest that the current restrictive use of RNI should be scrutinized, as the hazard-benefit relation appears to shift towards an improvement of outcome.

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Vessel based delineation guidelines for the elective lymph node regions in breast cancer radiation therapy – PROCAB guidelines

Cited by 46 publications

References 11 publications

Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research

Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research

Supine MRI for regional breast radiotherapy: imaging axillary lymph nodes before and after sentinel-node biopsy

Radiotherapy of the Lymphatic Pathways in Early Breast Cancer

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