Journal article
Quality of Regional Nodal Irradiation Plans in Breast Cancer Patients Across a Large Network-Can We Translate Results From Randomized Trials Into the Clinic?
Practical Radiation Oncology, v 11(1), pp E30-E35
01 Jan 2021
PMID: 32615162
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose: Regional nodal irradiation (RNI) improved disease-free survival by 3% to 5% in 2 large randomized trials, but this small absolute advantage relies on accurate contouring and dose delivery. We audited our network to determine compliance on regional nodal coverage, contouring, and dosimetric parameters with respect to accepted guidelines.
Methods and Materials: In our network, we have established a clinical pathway for patients with node-positive breast cancer that guides indications for RNI and dosimetric goals. We reviewed records of 183 patients with nodal macrometastases after upfront surgery or involved nodes of any size after neoadjuvant chemotherapy. Radiation treatment plans were examined to determine lymph node volumes treated, whether nodes were contoured, quality of nodal contours, and whether target coverage and normal organ dosimetric constraints were met when RNI was delivered.
Results: Despite the presence of macrometastases on sentinel lymph node biopsy, no lymph nodes were treated in 2.2% (4 of 183). Of 179 patients who received nodal irradiation, 18 received radiation to axillary levels 1 and 2 only, and 161 patients received RNI. Overall, regional nodes were not treated despite strong indications in 7.6% (14 of 183). Treated nodes were not contoured for 2.2% (4 of 179), and lymph node contours were unacceptable in 15.4% (27 of 175). Of patients receiving RNI, 14.9% (24 of 161) did not have adequate nodal target volume coverage, mean heart dose was >4 Gy for 3.1% (5 of 161), and lung V20 Gy was >35% for 8.7% (14 of 161).
Conclusions: Adherence to indications for regional nodal treatment was high, but nodes were either not contoured or had unacceptable contour quality in 18% of plans, and coverage was inadequate in 15%. Because the small disease-free survival advantage seen in trials may be decreased with these deviations, routine clinical practice requires detailed peer review to fully translate results of clinical trials. (C) 2020 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
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Details
- Title
- Quality of Regional Nodal Irradiation Plans in Breast Cancer Patients Across a Large Network-Can We Translate Results From Randomized Trials Into the Clinic?
- Creators
- Diane C. Ling - UPMC Hillman Cancer CenterBryanna L. Moppins - Augusta University HealthColin E. Champ - Duke Medical CenterVikram C. Gorantla - Magee-Womens HospitalSushil Beriwal - Magee-Womens Hospital
- Publication Details
- Practical Radiation Oncology, v 11(1), pp E30-E35
- Publisher
- Elsevier
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000607726300011
- Scopus ID
- 2-s2.0-85088796812
- Other Identifier
- 991021897276404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Oncology
- Radiology, Nuclear Medicine & Medical Imaging