Delineation of Internal Mammary Nodal Target Volumes in Breast Cancer Radiation Therapy

Jethwa, Krishan R.; Kahila, Mohamed M.; Hunt, Katie N.; Brown, Laura A.; Corbin, Kimberly S.; Park, Sean S.; Yan, Elizabeth; Boughey, Judy C.; Mutter, Robert W.

doi:10.1016/j.ijrobp.2016.11.037

Cited by 33 publications

(31 citation statements)

References 33 publications

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“…Most consisted of a mixture of patients with nodal disease at diagnosis (Brown et al ,. Jethwa et al . and Gentile et al …”

Section: Resultsmentioning

confidence: 96%

“…Jethwa et al . delineated the locations of IMN metastases (the majority at primary diagnosis) against RTOG target volumes.…”

Section: Resultsmentioning

confidence: 99%

“…found the majority of IMC metastases were located in the first three intercostal spaces, whereas only a few were caudal to the fourth rib. This was similar to that of Jethwa et al., and does not support routinely lowering the caudal margin of CTV. However, the use of a margin on the IMC vessels (rather than only the vessel itself) is supported by patterns of failure.…”

Section: Discussionmentioning

confidence: 99%

“…There is a greater risk of recurrence if microscopic disease is inadequately treated, but the risk of acute and late toxicity increases if excessive normal tissue is included in the field . Several international studies have been published recently reporting failure patterns of the commonly utilised breast contouring guidelines . These are timely to inform debate.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Most consisted of a mixture of patients with nodal disease at diagnosis (Brown et al ,. Jethwa et al . and Gentile et al …”

Section: Resultsmentioning

confidence: 96%

“…Jethwa et al . delineated the locations of IMN metastases (the majority at primary diagnosis) against RTOG target volumes.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Therefore, standard photon fields used to treat breast cancer may still deliver significant dose to nodal basins that are potentially at risk of harboring microscopic disease, even if they are not intentionally targeted [74]. For example, clinical target volumes according to the RTOG breast cancer atlas omit coverage of the posterolateral supraclavicular fossa (posterior triangle), yet a standard anterioroblique supraclavicular photon therapy field used to target the RTOG supraclavicular target volume will still cover the posterior triangle with a dose expected to control microscopic disease.…”

Section: Target Localizationmentioning

confidence: 99%

Proton Therapy for Breast Cancer: Progress & Pitfalls

Corbin

Mutter

2018

Breast Cancer Manag.

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Practice points• Proton therapy is under investigation for early stage and locally advanced breast cancer.• Due to unique physical properties, proton therapy reduces the dose to the heart, lungs, skin, muscle, and bone and is therefore hypothesized to reduce side effects from treatment.• Proton therapy may also enable improved target coverage in some breast cancer patients.• Due to its highly conformal nature, proton therapy requires careful attention to target volume delineation and implementation of strategies to mitigate uncertainties in setup and delivery.• Proton therapy for breast cancer is rapidly evolving with improvements in techniques for treatment delivery and optimizing of dose and fractionation schedules.• Research is ongoing to determine whether proton therapy improves treatment outcomes and quality of life compared with conventional photon techniques.As the number of patients cured from breast cancer increases with improvements in multidisciplinary care, emphasis on reducing late toxicities of treatment has increased, in order to improve long-term quality of life. Proton beam therapy (PBT) is a form of radiotherapy that uses particles with unique physical properties that enable treatment delivery with minimal dose deposition beyond the treatment target. Therefore, PBT has emerged as an exciting radiotherapy modality for breast cancer due to the ability to minimize exposure to the heart, lungs, muscle, and bone. Herein, we review the rationale for PBT in breast cancer, potential clinical applications, and the available clinical data supporting its use. We also address some of the technical and logistical challenges and areas of ongoing research that will ultimately establish the role for PBT for breast cancer in the years ahead.First draft submitted: 5 January 2018; Accepted for publication: 13 March 2018; Published online: 13 April 2018Keywords: breast cancer • cardiotoxicity • heart • particle therapy • pencil-beam scanning • proton therapy • radiation therapyBreast cancer accounts for 30% of new cancer diagnoses in women [1]. Although breast cancer remains the second leading cause of cancer death among women, advances in detection and treatment have resulted in improved outcomes, with 5-year expected survival of 90% [1]. Radiation therapy (RT) is indicated in the management of the majority of women with breast cancer [2]. For early stage breast cancer, breast irradiation following lumpectomy is an essential component of breast conserving therapy, lowering the risk of recurrence and improving breast cancer specific survival [3,4]. Recently published clinical trials also support the oncologic value of regional nodal irradiation (RNI) in some women with high risk node negative or axillary nodal metastases [5,6]. In addition, women with locally advanced breast cancer benefit from RT to the chest wall and regional lymph nodes, delivered in the post mastectomy setting [7]. While RT is widely utilized and improves breast cancer treatment outcomes, RT is also associated with late effects including cardi...

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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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Delineation of Internal Mammary Nodal Target Volumes in Breast Cancer Radiation Therapy

Cited by 33 publications

References 33 publications

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

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

Proton Therapy for Breast Cancer: Progress & Pitfalls

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

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