ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer, version 1.1

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.2015.12.027

Cited by 178 publications

(144 citation statements)

References 3 publications

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“…Local RT involves irradiation of only the residual breast after BCS, and it can be whole breast or partial breast treatment planning. Locoregional RT includes irradiation of the breast/chest wall and regional nodes, including all or selected levels I-IV, the Rötter nodes, and the internal mammary nodes [59,60]. …”

Section: The Radiation Therapy Perspectivementioning

confidence: 99%

“…After results were reported from the ACOSOG Z0011 trial, it became clear that there had been virtually no control during the trial on details of the RT, so it was stated that ‘high tangents' after BCS were recommended [65]. Using modern RT techniques based on meticulous target volume delineation followed by conformal radiation treatment planning to ensure optimal dose homogeneity and as low a dose as possible to organs at risk, ‘high tangents' are not an option [59,60]. In women who have been influenced by gravity for many years, there may be several centimeters from the caudal edge of the humeral head to the cranial edge of the clinical target volume of the residual breast, thus radiation dose to level I is often very modest if the patient is not having locoregional RT.…”

Section: The Radiation Therapy Perspectivementioning

confidence: 99%

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Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Reimer

Engel²,

Schmidt

et al. 2018

Breast Care

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Local treatment of the axilla in clinically node-negative (cN0) early breast cancer patients with routine sentinel lymph node biopsy (SLNB) is debated for various reasons: i) pN staging information may not be necessary for the postoperative treatment decision regarding adjuvant systemic therapy in the great majority of patients; ii) the SLNB-positive rate is declining below 20% in specialized breast centers; iii) albeit being a minimally invasive procedure, SLNB causes a significant reduction in quality of life in 23% of patients; and iv) previous randomized trials from the pre-SLNB era did not show a disadvantage for patients without axillary surgery with regard to overall survival. These data support the hypothesis that avoiding axillary treatment in patients with clinically and sonographically unsuspicious lymph nodes seems to be a safe option, although omitting axillary surgery may increase the risk of locoregional recurrence. Currently, the information regarding node-positive status is essential to guide postoperative treatment such as systemic or radiation therapies in a non-negligible minority of patients. Three ongoing prospective European trials (SOUND, INSEMA, BOOG 2013-08) with axillary observation alone versus SLNB in cN0 patients and primary breast-conserving surgery have the objective to evaluate oncologic safety when omitting SLNB.

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Section: The Radiation Therapy Perspectivementioning

confidence: 99%

Section: The Radiation Therapy Perspectivementioning

confidence: 99%

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Reimer

Engel²,

Schmidt

et al. 2018

Breast Care

View full text Add to dashboard Cite

show abstract

“…A recent ESTRO guideline suggests a more inferior superior border at the cranial edge is at the subclavian artery and does not target tissues medial to the internal jugular vein (i.e. excludes the carotid artery) [8]. These recommended volumes are based on a Danish analysis that reported a limited number of regional recurrences in this area irrespective of the radiation dose [9].…”

Section: Toxicities and Nodal Target Volumesmentioning

confidence: 99%

“…One must strike a balance between target coverage and normal tissue risks. Going forward, it seems prudent to define our target volumes smaller (more conservatively) in order to better spare adjacent normal structures, and/or accept some level of under-dosing in 'less at-risk' portions of the CTV [8].…”

Section: Shortcomings To This Reviewmentioning

confidence: 99%

Helical tomotherapy for bilateral breast cancer: Clinical experience

Kaidar‐Person¹,

Kostich²,

Zagar³

et al. 2016

The Breast

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“…This includes using modern radiation facilities to obtain a homogeneous dose distribution in the target volumes that are clearly defined and delineated according to the ESTRO target volume consensus, respiratory control during RT, and informing the patient about the risks from continuing smoking if she is a smoker [44,45,46]. The risk of late radiation-induced morbidity after modern RT is no doubt less than described in previous reports from patients treated decades ago.…”

Section: What Is the Best Management Of Cn0pn1(sn) Breast Cancer Patimentioning

confidence: 99%

What Is the Best Management of cN0pN1(sn) Breast Cancer Patients

et al. 2018

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Although the majority of breast cancer patients are clinically node-negative (cN0) at diagnosis, 15-20% will have a metastatic sentinel lymph node (SLN, pN1(sn)). While a less radical approach regarding axillary surgery in cN0 patients with a positive SLN biopsy is advocated, the limitations of 5 published trials on axillary management in pN1(sn) are discussed intensely in the literature and support the performance of ongoing validation and extension trials, especially considering the lack of data in the setting of mastectomy. As locoregional radiotherapy has a significant effect on both recurrence and survival, a standardization of locoregional radiotherapy in the situation of SLN biopsy alone in pN1(sn) patients has to be defined in the future, and de-escalation trials should embrace a truly multidisciplinary approach. This is also of utmost importance considering the fact that high-volume nodal disease requires an intensified adjuvant chemotherapy strategy to which patients omitting axillary dissection cannot be stratified. Finally, there is mounting evidence that the therapeutic role of extensive axillary surgery in low-volume nodal disease is negligible, and multidisciplinary and translational efforts must be undertaken to individualize treatment in order to gain a reasonable balance between necessary staging information and unnecessary treatment-related morbidity.

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ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer, version 1.1

Cited by 178 publications

References 3 publications

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Helical tomotherapy for bilateral breast cancer: Clinical experience

What Is the Best Management of cN0pN1(sn) Breast Cancer Patients

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