Loco-regional conformal radiotherapy of the breast: delineation of the regional lymph node clinical target volumes in treatment position

Treatment Optimization Using Computed Tomography-Delineated Targets Should be Used for Supraclavicular Irradiation for Breast Cancer

“…We found that the mean maximum depth of supraclavicular and axillary level III nodal beds was 3.2 cm (range, 1.4-6.7 cm) and 3.1 cm (range, 1.7-5.8 cm), respectively. These findings were comparable with the previous reports that showed the mean depth of SC nodes was 3.9-6 cm (range, 2.1-8.3 cm) (4)(5)(6)(7)(8), and the mean depth of the axillary level III nodal bed was 3.6-6.7 cm (range, 1.9-7.4 cm). This variation in the depth of both nodal beds suggested the need for customized radiation treatment rather than the use of routine radiation prescription.…”

Post-mastectomy radiotherapy in Denmark: From 2D to 3D treatment planning guidelines of The Danish Breast Cancer Cooperative Group

“…Delineation of regional lymph nodes (LN) was performed according to the guidelines of Dijkema et al [10]. One radiation oncologist carried out the delineation of the internal mammary LN's (IMN) in the first four intercostal (IC) spaces on all patients.…”

Caught in the Middle: Case Study of a Brachial (Sentry) Lymph Node Recurrence after Resection and Locoregional Breast Radiotherapy

“…When the three-dimensional topography of this sentry lymph node was delineated on the planning ct, with the arm abducted in treatment position (>90 degrees), the node's position coincided with the lateral extent of the level i ax lymph node boundaries described by Dijkema et al 8 in a study of the nodal clinical target volumes for breast radiotherapy (Figure 2). Guidelines set out by those authors suggest that cranially, the level of the ax level i target volumes should fall caudal to the tendon of the latissimus dorsi muscle.…”

“…In our case, the patient underwent locoregional radiotherapy involving both the scf and ax fields according to departmental guideline for post-mastectomy patients with 4 or more positive lymph nodes. Were we to contour the ax level i nodes as recommended by Djikema et al 8 , the lateral field border would extend more than 2 cm beyond the humeral head to cover the sentry node within the planning target volume, likely increasing the risk of lymphedema.…”