Contouring Guidelines for the Axillary Lymph Nodes for the Delivery of Radiation Therapy in Breast Cancer: Evaluation of the RTOG Breast Cancer Atlas

Gentile, Michelle S.; Usman, Asad; Neuschler, Erin; Sathiaseelan, V.; Hayes, John P.; Small, William

doi:10.1016/j.ijrobp.2015.07.002

Cited by 59 publications

(46 citation statements)

References 23 publications

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“…Six Megavolts photon beams of Synergy or Axesse linacs (Elekta, Stockholm, Sweden), available in the department, were used for the treatments. Experienced radiation oncologists conducted the target and organs at risk delineation according to the breast cancer atlas for the radiation therapy planning consensus definitions of the Radiation Therapy Oncology Group . The plan consisted of one or two arcs for the VMAT technique, whereas five beams were delivered via a step‐and‐shoot technique for IMRT.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of interfraction setup variations for postmastectomy radiation therapy using EPID‐based in vivo dosimetry

Kang

et al. 2019

J Applied Clin Med Phys

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Postmastectomy radiation therapy is technically difficult and can be considered one of the most complex techniques concerning patient setup reproducibility. Slight patient setup variationsparticularly when high-conformal treatment techniques are usedcan adversely affect the accuracy of the delivered dose and the patient outcome. This research aims to investigate the inter-fraction setup variations occurring in two different scenarios of clinical practice: at the reference and at the current patient setups, when an image-guided system is used or not used, respectively.The results were used with the secondary aim of assessing the robustness of the patient setup procedure in use. Forty eight patients treated with volumetric modulated arc and intensity modulated therapies were included in this study. EPID-based in vivo dosimetry (IVD) was performed at the reference setup concomitantly with the weekly cone beam computed tomography acquisition and during the daily current setup. Three indices were analyzed: the ratio R between the reconstructed and planned isocenter doses, γ% and the mean value of γ from a transit dosimetry based on a two-dimensional γ-analysis of the electronic portal images using 5% and 5 mm as dose difference and distance to agreement gamma criteria; they were considered in tolerance if R was within 5%, γ% > 90% and γ mean < 0.4. One thousand and sixteen EPID-based IVD were analyzed and 6.3% resulted out of the tolerance level.Setup errors represented the main cause of this off tolerance with an occurrence rate of 72.2%. The percentage of results out of tolerance obtained at the current setup was three times greater (9.5% vs 3.1%) than the one obtained at the reference setup, indicating weaknesses in the setup procedure. This study highlights an EPID-based IVD system's utility in the radiotherapy routine as part of the patient's treatment quality controls and to optimize (or confirm) the performed setup procedures' accuracy. K E Y W O R D Sbreast radiotherapy, in vivo dosimetry, volumetric modulated arc therapy ---

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Section: Methodsmentioning

confidence: 99%

Evaluation of interfraction setup variations for postmastectomy radiation therapy using EPID‐based in vivo dosimetry

Kang

et al. 2019

J Applied Clin Med Phys

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“…Gentile et al . evaluated 30 patients with clinically involved axillary lymph nodes on pretreatment CT against RTOG volumes.…”

Section: Resultsmentioning

confidence: 99%

“…found that most recurrences in axilla levels I and II were within the ESTRO CTV, with a low number of recurrences in level III. An unusual study design – mapping pretreatment axillary lymph nodes detectable on CT onto simulation CTs (performed after neoadjuvant chemotherapy and dissection) – found that most patients had an aspect of the presumed involved lymph node lying outside the anatomical borders of an axillary level . The clinical significance of these gross nodes (compared with a more standard microscopic disease setting) is unclear.…”

Section: Discussionmentioning

confidence: 99%

Contouring consensus guidelines in breast cancer radiotherapy: Comparison and systematic review of patterns of failure

et al. 2018

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Summary Adequate coverage of sites harbouring potential microscopic disease is paramount, where the clinical decision has been made to include regional lymph node radiotherapy for patients with breast cancer. This must be achieved in balance with minimising dose to normal tissues. Several international consensus guidelines detailing clinical target volumes (CTVs) are available, but there is currently no agreement as to which is most appropriate for a given clinical situation. Contouring guidelines are beneficial for routine practice and essential for clinical trial quality assurance. The aims of this study were as follows: to provide a single point of comparison of four commonly used contouring guidelines, including one used in a current Trans‐Tasman Radiation Oncology Group trial; and to undertake a systematic review of existing studies which map sites of breast cancer recurrence against contouring guidelines. Two international consensus guidelines (European Society for Radiotherapy and Oncology, and Radiation Therapy Oncology Group) were compared with two clinical trial guidelines (TROG 12.02 PET LABRADOR and the Proton/Photon trial NCT02603341 RADCOMP). Comprehensive literature search for patterns of failure studies was undertaken using Embase and Pubmed. We detail the small but significant differences between the breast consensus guidelines, particularly the supraclavicular (SCF) and internal mammary chain CTVs. Seven series were found mapping recurrence patterns. These results are discussed in the context of the contouring guidelines. Several studies found the SCF CTV is the area at greatest risk of geographical ‘miss’. This review will facilitate further discussion about guideline selection and modification, particularly for future clinical trials in Australia and New Zealand.

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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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Contouring Guidelines for the Axillary Lymph Nodes for the Delivery of Radiation Therapy in Breast Cancer: Evaluation of the RTOG Breast Cancer Atlas

Cited by 59 publications

References 23 publications

Evaluation of interfraction setup variations for postmastectomy radiation therapy using EPID‐based in vivo dosimetry

Evaluation of interfraction setup variations for postmastectomy radiation therapy using EPID‐based in vivo dosimetry

Contouring consensus guidelines in breast cancer radiotherapy: Comparison and systematic review of patterns of failure

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

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