PMID- 30078523
OWN - NLM
STAT- MEDLINE
DCOM- 20191213
LR  - 20240210
IS  - 1433-2981 (Electronic)
IS  - 0936-6555 (Linking)
VI  - 31
IP  - 1
DP  - 2019 Jan
TI  - Evaluation of a Novel Field-placement Algorithm for Locoregional Breast Cancer 
      Radiotherapy Including the Internal Mammary Chain.
PG  - 25-33
LID - S0936-6555(18)30311-X [pii]
LID - 10.1016/j.clon.2018.06.014 [doi]
AB  - AIMS: Irradiation of the internal mammary chain (IMC) is increasing following 
      recently published data, but the need for formal delineation of lymph node 
      volumes is slowing implementation in some healthcare settings. A field-placement 
      algorithm for irradiating locoregional lymph nodes including the IMC could reduce 
      the resource impact of introducing irradiation of the IMC. This study describes 
      the development and evaluation of such an algorithm. MATERIALS AND METHODS: An 
      algorithm was developed in which six points representing lymph node clinical 
      target volume borders (based on European Society for Radiotherapy and Oncology 
      consensus nodal contouring guidelines) were placed on computed tomography-defined 
      anatomical landmarks and used to place tangential and nodal fields. Single-centre 
      testing in 20 cases assessed the success of the algorithm in covering planning 
      target volumes (PTVs) and adequately sparing organs at risk. Plans derived using 
      the points algorithm were also compared with plans generated following formal 
      delineation of nodal PTVs, using the Wilcoxon signed rank test. Timing data for 
      point placement were collected. Multicentre testing using the same methods was 
      then carried out to establish whether the technique was transferable to other 
      centres. RESULTS: Single-centre testing showed that 95% of cases met the nodal 
      PTV coverage dose constraints (binomial probability confidence interval 
      75.1-99.9%) with no statistically significant reduction in mean heart dose or 
      ipsilateral lung V(17Gy) associated with formal nodal delineation. In multicentre 
      testing, 69% of cases met nodal PTV dose constraints and there was a 
      statistically significant difference in IMC PTV coverage using the points 
      algorithm when compared with formally delineated nodal volumes (P < 0.01). 
      However, there was no difference in axillary level 1-4 PTV coverage (P = 0.11) 
      with all cases meeting target volume constraints. CONCLUSIONS: The optimal 
      strategy for breast and locoregional lymph node radiotherapy is target volume 
      delineation. However, use of this novel points-based field-placement algorithm 
      results in dosimetrically acceptable plans without the need for formal lymph node 
      contouring in a single-centre setting and for the breast and level 1-4 axilla in 
      a multicentre setting. Further quality assurance measures are needed to enable 
      implementation of the algorithm for irradiation of the IMC in a multicentre 
      setting.
CI  - Copyright (c) 2018. Published by Elsevier Ltd.
FAU - Ranger, A
AU  - Ranger A
AD  - The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation 
      Trust, London, UK. Electronic address: alison.ranger@icr.ac.uk.
FAU - Dunlop, A
AU  - Dunlop A
AD  - The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation 
      Trust, London, UK.
FAU - Shah, P
AU  - Shah P
AD  - The Royal Marsden NHS Foundation Trust, London, UK.
FAU - Amin, K
AU  - Amin K
AD  - The Royal Marsden NHS Foundation Trust, London, UK.
FAU - Henderson, D
AU  - Henderson D
AD  - University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
FAU - Bartlett, F R
AU  - Bartlett FR
AD  - Queen Alexandra Hospital, Portsmouth, UK.
FAU - Knowles, C
AU  - Knowles C
AD  - The Royal Marsden NHS Foundation Trust, London, UK.
FAU - Brigden, B
AU  - Brigden B
AD  - The Royal Marsden NHS Foundation Trust, London, UK.
FAU - Lacey, C
AU  - Lacey C
AD  - The Royal Marsden NHS Foundation Trust, London, UK.
FAU - Donovan, E
AU  - Donovan E
AD  - CVSSP, University of Surrey, Guildford, UK.
FAU - Harris, E
AU  - Harris E
AD  - The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation 
      Trust, London, UK.
FAU - Kirby, A M
AU  - Kirby AM
AD  - The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation 
      Trust, London, UK.
LA  - eng
GR  - 19727/CRUK_/Cancer Research UK/United Kingdom
GR  - PB-PG-1010-23003/DH_/Department of Health/United Kingdom
GR  - C33589/A19727/CRUK_/Cancer Research UK/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180802
PL  - England
TA  - Clin Oncol (R Coll Radiol)
JT  - Clinical oncology (Royal College of Radiologists (Great Britain))
JID - 9002902
SB  - IM
MH  - Algorithms
MH  - Breast Neoplasms/*radiotherapy
MH  - Female
MH  - Humans
MH  - Lymph Nodes/*pathology
MH  - Mammary Arteries/*radiation effects
OTO - NOTNLM
OT  - Heart-sparing radiotherapy
OT  - internal mammary chain radiotherapy
OT  - resource-sparing radiotherapy techniques
EDAT- 2018/08/07 06:00
MHDA- 2019/12/18 06:00
CRDT- 2018/08/07 06:00
PHST- 2018/04/15 00:00 [received]
PHST- 2018/06/18 00:00 [revised]
PHST- 2018/06/25 00:00 [accepted]
PHST- 2018/08/07 06:00 [pubmed]
PHST- 2019/12/18 06:00 [medline]
PHST- 2018/08/07 06:00 [entrez]
AID - S0936-6555(18)30311-X [pii]
AID - 10.1016/j.clon.2018.06.014 [doi]
PST - ppublish
SO  - Clin Oncol (R Coll Radiol). 2019 Jan;31(1):25-33. doi: 
      10.1016/j.clon.2018.06.014. Epub 2018 Aug 2.