Mapping patterns of locoregional recurrence following contemporary treatment with radiation therapy for breast cancer: A multi-institutional validation study of the ESTRO consensus guideline on clinical target volume

Chang, Jee Suk; Lee, Jeongshim; Chun, Mison; Shin, Kyung Hwan; Park, Won; Lee, Jong Hoon; Kim, Jin Hee; Yoon, Won Sup; Lee, Ik Jae; Kim, Juree; Park, Hye Li; Kim, Yong Bae

doi:10.1016/j.radonc.2017.09.031

Cited by 45 publications

(52 citation statements)

References 18 publications

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“…The most consistent finding was that the posterior neck region, posterolateral to RTOG and ESTRO volumes, was a site of metastasis or recurrence in three series (Fig. b,c).…”

Section: Discussionsupporting

confidence: 57%

“…The exact frequency and risk of this recurrence is difficult to assess, and reflects the composition of the case series, with higher rates of theoretical ‘miss’ associated with higher nodal disease burden, stage IV disease, and possibly lower rates of current standard chemotherapy. In both papers by Chang et al ., which only examined recurrent lesions, the rate of SCF LN metastases outside the ESTRO/RTOG CTV was lower than in the other two series, which also included patients who presented with SCF metastases at diagnosis . However, taken together, these studies suggest that the posterior volume, which extends beyond the scalene muscles, is at risk from metastatic breast cancer.…”

Section: Discussionmentioning

confidence: 89%

“…In the large, multi‐institutional study by Chang et al ., recurrent nodal lesions were evaluated against ESTRO and RTOG CTVs. All patients experienced LRR (the majority of which were solitary), and had been treated initially with surgery followed by adjuvant therapy in the anti‐HER2 era.…”

Section: Resultsmentioning

confidence: 99%

“…). On the one hand, one multi‐institutional study found that 9% of supraclavicular lesions were superior to the ESTRO volume, all within 6 mm of the cranial border (subclavian artery) . In contrast, a large single institution database of 73 patients with 101 regional recurrences (patients treated 2000–2013 with fields similar to the ESTRO guidelines), found no evidence for enlarging the SCF borders (or indeed, the other regional nodal CTVs) …”

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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“…The most consistent finding was that the posterior neck region, posterolateral to RTOG and ESTRO volumes, was a site of metastasis or recurrence in three series (Fig. b,c).…”

Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 89%

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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Breast Cancer

Bradley¹,

Liang²

2022

Principles and Practice of Particle Therapy

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Hypofractionated volumetric‐modulated arc therapy for breast cancer: A propensity‐score‐weighted comparison of radiation‐related toxicity

Kim

Chang

Shah

et al. 2021

Intl Journal of Cancer

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We assessed the clinical benefit of combining volumetric‐modulated arc therapy (VMAT) and hypofractionated radiotherapy (HF‐RT) considering the incidence of radiation‐related toxicities. After a retrospective review for breast cancer patients treated with adjuvant RT between 2005 and 2017, a total of 4209 patients treated with three‐dimensional conventional fractionation (CF‐3D, 50.4 Gy/28 fractions) and 1540 patients treated with HF‐RT (768 received HF‐3D; 772, HF‐VMAT; 40 Gy/15 fractions) were included. A total of 2229 patients (38.8%) received regional node irradiation (RNI): 1642 (39.0%), 167 (21.7%) and 420 (54.4%) received RNI via CF‐3D, HF‐3D and HF‐VMAT, respectively. Acute/subacute and late toxicities were evaluated. Propensity scores were calculated via logistic regression. Grade 2+ acute/subacute toxicities was the highest in CF‐3D group (15.0%, 2.6% and 1.6% in CF‐3D, HF‐3D and HF‐VMAT, respectively; P < .001). HF‐VMAT reduced Grade 2+ acute/subacute toxicities significantly compared to CF‐3D (odds ratio [OR] 0.11, P < .001) and HF‐3D (OR 0.45, P = .010). The 3‐year cumulative rate of late toxicities was 18.0% (20.1%, 10.9% and 13.4% in CF‐3D, HF‐3D and HF‐VMAT, respectively; P < .001). On sensitivity analysis, the benefit of HF‐VMAT was high in the RNI group. Acute and late toxicities were fewer after HF‐VMAT than after HF‐3D or CF‐3D, especially in women who underwent RNI.

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Mapping patterns of locoregional recurrence following contemporary treatment with radiation therapy for breast cancer: A multi-institutional validation study of the ESTRO consensus guideline on clinical target volume

Cited by 45 publications

References 18 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

Breast Cancer

Hypofractionated volumetric‐modulated arc therapy for breast cancer: A propensity‐score‐weighted comparison of radiation‐related toxicity

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