Publikation: Zeitschriftenartikel

Central review of radiation therapy planning among patients with breast-conserving surgery

Grunddaten
Abstract
Autoren
Einrichtung

Grunddaten

Titel	Central review of radiation therapy planning among patients with breast-conserving surgery
Untertitel	results from a quality assurance process integrated into the INSEMA trial
Erscheinungsjahr	2020
Seiten (von – bis)	683 – 693
Band	107
Heft-Nr.	4
Jahr	2020
Publikationsform	Elektronische Ressource
Publikationsart	Zeitschriftenartikel
Sprache	Englisch
DOI	10.1016/j.ijrobp.2020.04.042
Letzte Änderung	11.01.2022 06:03:06
Bearbeitungsstatus	durch UB Rostock abschließend validiert
Dauerhafte URL	http://purl.uni-rostock.de/fodb/pub/67041
Links zu Katalogen

Abstract

Purpose - After publication of the radiation field design in the American College of Surgeons Oncology Group Z0011 trial, a radiation therapy quality assurance review was integrated into the Intergroup-Sentinel-Mamma (INSEMA) trial. We aimed to investigate the role of patient characteristics, extent of axillary surgery, and radiation techniques for dose distribution in ipsilateral axillary levels. - Methods and Materials - INSEMA (NCT02466737) has randomized 5542 patients who underwent breast-conserving surgery. Of these, 276 patients from 108 radiation therapy facilities were included in the central review, using the planning records of the first 3 patients treated at each site. - Results - Of the 276 patients, 41 had major deviations (ie, no axillary contouring or submission of insufficient records) leading to exclusion. A total of 235 (85.1%) radiation therapy planning records were delineated according to the INSEMA protocol, including 9 (3.8%) cases with minor deviations. At least 25% of INSEMA patients were unintentionally treated with 95% of the prescribed breast radiation dose in axillary level I. Approximately 50% of patients were irradiated with a median radiation dose of more than 85% of prescription dose in level I. Irradiated volumes and applied doses were significantly lower in levels II and III compared with level I. However, 25% of patients still received a median radiation dose of 75% of prescription dose to level II. Subgroup analysis revealed a significant association between incidental radiation dose in the axilla and obesity. Younger age, boost application, and fractionation schedule showed no impact on axillary dose distribution. - Conclusions - Assuming 80% of prescribed breast dose as the optimal dose for curative radiation of low-volume disease in axillary lymph nodes, at least 50% of reviewed INSEMA patients received an adequate dose in level I, even with contemporary 3-dimensional techniques. Dose coverage was much less in axillary levels II and III, and far below therapeutically relevant doses.

Autoren

Hildebrandt, Guido
Stachs, Angrit
Gerber, Bernd
Potenberg, Jochem
Krug, David
Wolter, Kathi
Kühn, Thorsten
Zierhut, Dietmar
Sedlmayer, Felix
Kaiser, Julia
Reitsamer, Roland
Heil, Jörg
Nekljudova, Valentina
Bekes, Inga
Loibl, Sibylle
Reimer, Toralf

Einrichtung

UMR/Klinik und Poliklinik für Strahlentherapie