Optimal Target Delineation and Treatment Techniques in the Era of Conformal Photon and Proton Breast and Regional Nodal Irradiation

Kowalski, E.S.; Feigenberg, Steven J.; Cohen, Justin D.; Fellows, Zachary; Vadnais, P.; Rice, Stephanie R.; Mishra, Mark V.; Molitoris, Jason K.; Nichols, Elizabeth M.; Snider, J.W.

doi:10.1016/j.prro.2019.11.010

Cited by 16 publications

(11 citation statements)

References 15 publications

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“…All these SLNs were located cranially to the 4th rib and were successfully covered by ESTRO and RTOG contours. These data is in accordance with the previous experience that indicated that 90% of metastatic internal mammary LNs were detected in the 1st-3rd intercostals spaces [12,24,29] and were successfully covered by ESTRO, RTOG, and RADCOMP contours.…”

Section: Discussionsupporting

confidence: 93%

“…This is in accordance with existing PET-CT data indicating that the majority of metastatic lymph nodes in primary patients with breast cancer are located in the axilla (91.6%) [9]. According to Kowalski et al [12] in patients with advanced and recurrent disease regional metastases detected in the axillary LNs in 73% of all cases and in other 27% occupied internal mammary and supraclavicular regions.…”

Section: Discussionsupporting

confidence: 91%

“…Nielsen and Offersen [21] also concluded that ESTRO contours of supraclavicular area were correct and did not need enlargement. On the contrary, many authors reported that mapping of supraclavicular recurrent or clinically involved LNs demonstrated that around 20%-41% of metastases in this region were located out of RTOG and/or ESTRO contours and nearly always associated with an advanced nodal disease [9,12,20,22]. Usually missed metastatic supraclavicular LNs were found laterally to sternocleidomastoid muscles, posterior to the transverse process of the vertebral body [19,22,23] or cranial to the subclavian artery [24] mostly at the level of thyroid and cricoid cartilage [25].…”

Section: Discussionmentioning

confidence: 99%

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Atlas of sentinel lymph nodes in early breast cancer using single-photon emission computed tomography: implication for lymphatic contouring

Новиков¹,

Крживицкий²,

Melnik³

et al. 2021

Radiat Oncol J

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Purpose To determine the localization of sentinel lymph nodes (SLNs) in a large cohort of patients with breast cancer and validate the European Society for Therapeutic Radiology and Oncology (ESTRO), Radiation Therapy Oncology Group (RTOG), and Radiotherapy Comparative Effectiveness (RADCOMP) guidelines on regional lymph node clinical target volume (CTV-LN) delineation. Materials and Methods A total of 254 women with cT1-3N0-1M0 breast cancer underwent single-photon emission computed tomography (SPECT-CT) visualization of SLNs after intra- and peritumoral injection of 99mTc-radiocolloids. All SPECT-CT images were fused with reference simulation computed tomography. A 3D atlas of SLNs was created and used for evaluation of CTV-LN defined by contouring guidelines. Results SPECT-CT visualized 532 SLNs that were localized in axillary level I in 67.5%, level II in 15.4%, level III in 7.3%, internal mammary in 8.5%, and supraclavicular in 1.3% cases. The majority of level II–IV and internal mammary SLNs were inside the recommended CTV-LN. Axillary level I SLNs were covered by ESTRO and RTOG contours in 85% and 85% cases, respectively. “Out of contours” SLNs were mostly detected in lateral subgroup of level I LN (18.5%), while 98%–99% of anterior pectoral and central axillary SLNs were covered by CTV-LN. Internal mammary SLNs were visualized in 33 cases and were outside ESTRO and RTOG contours in 3 and 6 observations, respectively. Conclusion SPECT-CT atlas of SLNs demonstrated that in most cases ESTRO and RTOG guidelines correctly represented CTV-LNs with the exception of lateral subgroup of SLNs.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Atlas of sentinel lymph nodes in early breast cancer using single-photon emission computed tomography: implication for lymphatic contouring

Новиков¹,

Крживицкий²,

Melnik³

et al. 2021

Radiat Oncol J

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“…With advanced radiotherapy techniques, such as IMRT and proton beam therapy being used for RNI, precise CTV target definition is important to ensure accurate dose delivery. Kowalski et al published a study including 389 RNRs in 102 patients (3.8 RNR/patient) [22]. They compared the dosimetric coverage of FDG-avid lymph node metastases for plans created with the RTOG, ESTRO and RADCOMP atlases using 3D conformal, volumetricmodulated arc therapy (VMAT) and pencil-beam scanning proton therapy (PBSPT).…”

Section: Discussionmentioning

confidence: 99%

PET/CT of breast cancer regional nodal recurrences: an evaluation of contouring atlases

Beaton¹,

Nica²,

Tyldesley³

et al. 2020

Radiat Oncol

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Background: To validate the Radiation Therapy Oncology Group (RTOG) and European Society for Radiotherapy and Oncology (ESTRO) breast cancer nodal clinical target volumes (CTVs) and to investigate the Radiotherapy Comparative Effectiveness Consortium (RADCOMP) Posterior Neck volume in relation to regional nodal recurrences (RNR). Methods: From a population-based database, 69 patients were identified who developed RNR after curative treatment for breast cancer. RNRs were detected with 18-fluorodeoxyglucose-positron emission tomographycomputed tomography (PET/CT). All patients were treatment-naïve for RNR when imaged. The RTOG and ESTRO nodal CTVs and RADCOMP Posterior Neck volumes were contoured onto a template patient's CT. RNRs were contoured on each PET/CT and deformed onto the template patient's CT. Each RNR was represented by a 5 mm diameter epicentre, and categorized as 'inside', 'marginal' or 'outside' the CTV boundaries. Results: Sixty-nine patients with 226 nodes (median 2, range 1-11) were eligible for inclusion. Thirty patients had received adjuvant tangent and regional nodal radiotherapy, 16 tangent-only radiotherapy and 23 no adjuvant radiotherapy. For the RTOG CTVs, the RNR epicentres were 70% (158/226) inside, 4% (8/226) marginal and 27% (60/ 226) outside. They included the full extent of the RNR epicentres in 38% (26/69) of patients. Addition of the RADCOMP Posterior Neck volume increased complete RNR coverage to 48% (33/69) of patients. For the ESTRO CTVs, the RNR epicentres were 73% (165/226) inside, 2% (4/226) marginal and 25% (57/226) outside. They included the full extent of the RNR epicentres in 57% (39/69) of patients. Addition of the RADCOMP Posterior Neck volume increased complete RNR coverage to 70% (48/69) of patients. Conclusions: The RTOG and ESTRO breast cancer nodal CTVs do not fully cover all potential areas of RNR, but the ESTRO nodal CTVs provided full coverage of all RNR epicentres in 19% more patients than the RTOG nodal CTVs. With addition of the RADCOMP Posterior Neck volume to the ESTRO CTVs, 70% of patients had full coverage of all RNR epicentres.

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“…Beginning in late 2018, our institution now predominantly uses the RADCOMP atlas given concerns for undercoverage of nodal basins, particularly in the SCV region, when highly conformal RT techniques are used. 27 For patients with a clinically negative IMN chain, the internal mammary artery is contoured with an anatomic expansion to include the surrounding fat plane from the caudal border of the supraclavicular volume to the cranial edge of the fourth rib. The lung is not included in this volume.…”

Section: Rt Techniquesmentioning

confidence: 99%

Assessing the Need for Adjusted Organ-at-Risk Planning Goals for Patients Undergoing Adjuvant Radiation Therapy for Locally Advanced Breast Cancer with Proton Radiation

DeCesaris

Pollock

Zhang

et al. 2021

Practical Radiation Oncology

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Locally advanced breast cancer requires surgical management via lumpectomy or mastectomy with or without systemic therapy followed by chest wall or breast (CW) and comprehensive nodal irradiation (CNI). Radiation (RT) dose constraints for the heart and ipsilateral lung have been developed based on photon RT. Proton therapy (PBT) can deliver significantly lower doses of RT to these organs-at-risk (OARs) and may warrant adjustments to OAR planning goals. Methods and Materials: The RT plans of consecutive patients undergoing adjuvant CW-CNI RT with PBT within a single center were reviewed. A inital treatment volume, comprised of CW/intact breast þ CNI (CTV_init) structure, including the CW and CNI but excluding any boost plans was analyzed. Frequency distributions were generated based on doses received by the heart, lungs, and esophagus for validated dosimetric parameters. Frequency distributions were generated and then stratified by laterality and compared using the Kruskal-Wallis H test. The 75th, 85th, and 95th percentiles for each dosimetric parameter were calculated, overall and by laterality. The 75th percentile (Q3), was used as a suggested primary goal, and the 95th percentile was used as a suggested secondary goal. Results: One hundred and seventy-two plans were analyzed. Forty-nine plans were right-sided, 107 were left-sided, and 16 were bilateral. The overall Q3 of the mean and V25 of the heart were 1.5 Gy and 1.7%, respectively. The mean and V25 to the heart differed significantly by laterality. Pulmonary values were similar to current recommendations. For all lateralites, the median volume of the esophagus receiving 70% prescription dose was 1 cm 3. Conclusions: We present the first dosimetric study providing complete OAR dose-volume histograms data for patients undergoing adjuvant pencil-beam scanning-PBT for locally advanced breast cancer, with detailed information on central tendencies, ranges and distributions of data. We have provided suggested planning goals and metrics for the lungs, heart, and esophagus; the latter 2 differing Sources of support: No outside funding was used in the development of this manuscript.

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Optimal Target Delineation and Treatment Techniques in the Era of Conformal Photon and Proton Breast and Regional Nodal Irradiation

Cited by 16 publications

References 15 publications

Atlas of sentinel lymph nodes in early breast cancer using single-photon emission computed tomography: implication for lymphatic contouring

Atlas of sentinel lymph nodes in early breast cancer using single-photon emission computed tomography: implication for lymphatic contouring

PET/CT of breast cancer regional nodal recurrences: an evaluation of contouring atlases

Assessing the Need for Adjusted Organ-at-Risk Planning Goals for Patients Undergoing Adjuvant Radiation Therapy for Locally Advanced Breast Cancer with Proton Radiation

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