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7. Internal and external validation of an ESTRO delineation guideline – dependent automated segmentation tool for loco-regional radiation therapy of early breast cancer

Author

Eldesoky, Ahmed R., Yates, Esben S., Nyeng, Tine B., Thomsen, Mette S., Nielsen, Hanne M., Poortmans, Philip, Kirkove, Carine, Krause, Mechthild, Kamby, Claus, Mjaaland, Ingvil, Blix, Egil S., Jensen, Ingelise, Berg, Martin, Lorenzen, Ebbe L., Taheri-Kadkhoda, Zahra, and Offersen, Birgitte V.

Published
2016
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8. Partial Breast Irradiation Versus Whole Breast Irradiation for Early Breast Cancer Patients in a Randomized Phase III Trial:The Danish Breast Cancer Group Partial Breast Irradiation Trial

Author

Offersen, Birgitte V., Alsner, Jan, Nielsen, Hanne M., Jakobsen, Erik H., Nielsen, Mette H., Stenbygaard, Lars, Pedersen, Anders N., Thomsen, Mette S., Yates, Esben, Berg, Martin, Lorenzen, Ebbe L., Jensen, Ingelise, Josipovic, Mirjana, Jensen, Maj Britt, Overgaard, Jens, Offersen, Birgitte V., Alsner, Jan, Nielsen, Hanne M., Jakobsen, Erik H., Nielsen, Mette H., Stenbygaard, Lars, Pedersen, Anders N., Thomsen, Mette S., Yates, Esben, Berg, Martin, Lorenzen, Ebbe L., Jensen, Ingelise, Josipovic, Mirjana, Jensen, Maj Britt, and Overgaard, Jens

Abstract

PURPOSE: On the basis of low risk of local recurrence in elderly patients with breast cancer after conservative surgery followed by whole breast irradiation (WBI), the Danish Breast Cancer Group initiated the noninferiority external-beam partial breast irradiation (PBI) trial (ClinicalTrials.gov identifier: NCT00892814). We hypothesized that PBI was noninferior to WBI regarding breast induration. METHODS: Patients operated with breast conservation for relatively low-risk breast cancer were randomly assigned to WBI versus PBI, and all had 40 Gy/15 fractions. The primary end point was 3-year grade 2-3 breast induration. RESULTS: In total, 865 evaluable patients (434 WBI and 431 PBI) were enrolled between 2009 and 2016. Median follow-up was 5.0 years (morbidity) and 7.6 years (locoregional recurrence). The 3-year rate of induration was 9.7% for WBI and 5.1% for PBI (P = .014). Large breast size was significantly associated with induration with a 3-year incidence of 13% (WBI) and 6% (PBI) for large-breasted patients versus 6% (WBI) and 5% (PBI) for small-breasted patients. PBI showed no increased risk of dyspigmentation, telangiectasia, edema, or pain, and patient satisfaction was high. Letrozole and smoking did not increase the risk of radiation-associated morbidity. Sixteen patients had a locoregional recurrence (six WBI and 10 PBI; P = .28), 20 patients had a contralateral breast cancer, and eight patients had distant failure (five WBI and three PBI). A nonbreast second cancer was detected in 73 patients (8.4%), and there was no difference between groups. CONCLUSION: External-beam PBI for patients with low-risk breast cancer was noninferior to WBI in terms of breast induration. Large breast size was a risk factor for radiation-associated induration. Few recurrences were detected and unrelated to PBI.

Published
2022

9. Volume matters:Breast induration is associated with irradiated breast volume in the Danish Breast Cancer Group phase III randomized Partial Breast Irradiation trial

Author

Thomsen, Mette S., Alsner, Jan, Nielsen, Hanne M., Jakobsen, Erik H., Nielsen, Mette H., Møller, Mette, Pedersen, Anders N., Yates, Esben, Berg, Martin, Lorenzen, Ebbe, Jensen, Ingelise, Josipovic, Mirjana, Overgaard, Jens, Offersen, Birgitte V., Thomsen, Mette S., Alsner, Jan, Nielsen, Hanne M., Jakobsen, Erik H., Nielsen, Mette H., Møller, Mette, Pedersen, Anders N., Yates, Esben, Berg, Martin, Lorenzen, Ebbe, Jensen, Ingelise, Josipovic, Mirjana, Overgaard, Jens, and Offersen, Birgitte V.

Abstract

Purpose: The relation between breast induration grade 2–3 at 3 years after radiation therapy and irradiated breast volume was investigated for patients in the Danish Breast Cancer Group (DBCG) Partial Breast Irradiation (PBI) trial. METHODS Treatment plan data was obtained from the Danish radiotherapy plan database. Dosimetric parameters for breast and organs at risk were determined. Breast induration data was obtained from the DBCG database. The volume of the whole breast (CTVp_breast) treated to various dose levels was determined for treatment plans in both arms. Logistic regression was used to assess the frequency of induration on breast volume irradiated to ≥40 Gy. RESULTS PBI and WBI was given to 433 and 432 patients, respectively. Median and interquartile ranges (IQR) for CTVp_breast were 710 mL (467–963 mL; PBI) and 666 mL (443–1012 mL; WBI) (p = 0.98). Median and IQR for CTVp_breast treated to ≥40 Gy was 24.9% (18.6–32.6%; PBI) and 59.8% (53.6–68.5%; WBI). Grade 2–3 induration was observed in 5% (PBI) and 10% (WBI) of the patients. A dose–response relationship was established between irradiated breast volume and frequency of breast induration. From the model, 5% and 10% risks of breast induration were observed for ≥40 Gy delivered to CTVp_breast volumes of 177 mL (95%CI, 94–260 mL) and 426 mL (95%CI, 286–567 mL), respectively. CONCLUSION The frequency of breast induration increased significantly with increasing irradiated breast volume, strongly favouring small volumes and PBI. Thus, treated breast volume – not the breast size itself - is the risk factor for induration. This is the first report directly linking the 40 Gy irradiated breast volume to breast induration.

Published
2022

11. Partial Breast Irradiation Versus Whole Breast Irradiation for Early Breast Cancer Patients in a Randomized Phase III Trial: The Danish Breast Cancer Group Partial Breast Irradiation Trial.

Author

Offersen, Birgitte V., Alsner, Jan, Nielsen, Hanne M., Jakobsen, Erik H., Nielsen, Mette H., Stenbygaard, Lars, Pedersen, Anders N., Thomsen, Mette S., Yates, Esben, Berg, Martin, Lorenzen, Ebbe L., Jensen, Ingelise, Josipovic, Mirjana, Jensen, Maj-Britt, and Overgaard, Jens

Published
2022
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14. The potential benefits from respiratory gating for breast cancer patients regarding target coverage and dose to organs at risk when applying strict dose limits to the heart:results from the DBCG HYPO trial

Author

Berg, Martin, Lorenzen, Ebbe L, Jensen, Ingelise, Thomsen, Mette S, Lutz, Christina Maria, Refsgaard, Lasse, Nissen, Henrik D, and Offersen, Birgitte V

Subjects
Adult, Aged, 80 and over, Organs at Risk, Radiotherapy Planning, Computer-Assisted, Coronary Vessels/diagnostic imaging, Radiotherapy Dosage, Middle Aged, Heart/diagnostic imaging, Breath Holding, Journal Article, Humans, Female, Dose Fractionation, Radiation, Tomography, X-Ray Computed, Unilateral Breast Neoplasms/radiotherapy, Aged
Abstract

PURPOSE: The potential benefits from respiratory gating (RG) compared to free-breathing (FB) regarding target coverage and dose to organs at risk for breast cancer patients receiving post-operative radiotherapy (RT) in the DBCG HYPO multicentre trial are reported.MATERIAL AND METHODS: Patients included in the DBCG HYPO trial were randomized between 50 Gy in 25 fractions (normofractionated) versus 40 Gy in 15 fractions (hypofractionated). A tangential forward field-in-field dose planning technique was used to cover the clinical target volume (CTV) with the intent to limit dose to the left anterior descending coronary artery (LADCA) to 20 Gy and 17 Gy in the normo- and hypofractionated arms, respectively. Treatment plan data for 1327 patients from four Danish centres was retrospectively analyzed. FB right-sided patients served as control group for the left-sided patients regarding CTV V95% (relative volume receiving at least 95% of the prescribed dose), mean heart dose (MHD) and mean lung dose (MLD).RESULTS: Median CTV V95% was for FB right-sided, FB left-sided and RG left-sided patients 94.6, 92.6 and 94.7% for normofractionated therapy, respectively, and 94.6, 91.8 and 94.4% for hypofractionated therapy and did not differ significantly for RG left-sided plans compared to FB right-sided in either study arm. CTV V95% was significantly lower for FB versus RG for left-sided plans in both arms. Median MHD was 0.7, 1.8 and 1.5 Gy (normofractionated therapy) versus 0.6, 1.5 and 1.2 Gy (hypofractionated therapy), respectively. The corresponding median MLD was 9.0, 8.3 and 7.3 Gy versus 7.3, 6.4 and 5.8 Gy, respectively.CONCLUSIONS: RG for left-sided breast cancer patients ensured similar CTV V95% as for FB right-sided patients. MLD was lower for RG due to the increased lung volume. MHD was generally low due to strict protocol-defined maximum dose to LADCA, but for left-sided patients RG led to significantly lower MHD.

Published
2018
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15. The potential benefits from respiratory gating for breast cancer patients regarding target coverage and dose to organs at risk when applying strict dose limits to the heart: results from the DBCG HYPO trial

Author

Berg, Martin, primary, Lorenzen, Ebbe L., additional, Jensen, Ingelise, additional, Thomsen, Mette S., additional, Lutz, Christina Maria, additional, Refsgaard, Lasse, additional, Nissen, Henrik D., additional, and Offersen, Birgitte V., additional

Published
2017
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16. Quality assessment of delineation and dose planning of early breast cancer patients included in the randomized Skagen Trial 1.

Author

UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service de radiothérapie oncologique, Francolini, Giulio, Thomsen, Mette S, Yates, Esben S, Kirkove, Carine, Jensen, Ingelise, Blix, Egil S, Kamby, Claus, Nielsen, Mette H, Krause, Mechthild, Berg, Martin, Mjaaland, Ingvil, Schreiber, Andreas, Kasti, Unn-Miriam, Boye, Kristian, Offersen, Birgitte V, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service de radiothérapie oncologique, Francolini, Giulio, Thomsen, Mette S, Yates, Esben S, Kirkove, Carine, Jensen, Ingelise, Blix, Egil S, Kamby, Claus, Nielsen, Mette H, Krause, Mechthild, Berg, Martin, Mjaaland, Ingvil, Schreiber, Andreas, Kasti, Unn-Miriam, Boye, Kristian, and Offersen, Birgitte V

Abstract

BACKGROUND AND PURPOSE: To report on a Quality assessment (QA) of Skagen Trial 1, exploring hypofractionation for breast cancer patients with indication for regional nodal radiotherapy. MATERIAL AND METHODS: Deviations from protocol regarding target volume delineations and dose parameters (Dmin, Dmax, D98%, D95% and D2%) from randomly selected dose plans were assessed. Target volume delineation according to ESTRO guidelines was obtained through atlas based automated segmentation and centrally approved as gold standard (GS). Dice similarity scores (DSC) with original delineations were measured. Dose parameters measured in the two delineations were reported to assess their dosimetric outcome. RESULTS: Assessment included 88 plans from 12 centres in 4 countries. DSC showed high agreement in contouring, 99% and 96% of the patients had a complete delineation of target volumes and organs at risk. No deviations in the dosimetric outcome were found in 76% of the patients, 82% and 95% of the patients had successful coverage of breast/chestwall and CTVn_L2-4-interpectoral. Dosimetric outcomes of original delineation and GS were comparable. CONCLUSIONS: QA showed high protocol compliance and adequate dose coverage in most patients. Inter-observer variability in contouring was low. Dose parameters were in harmony with protocol regardless original or GS segmentation.

Published
2017

17. Internal and external validation of an ESTRO delineation guideline - dependent automated segmentation tool for loco-regional radiation therapy of early breast cancer.

Author

UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service de radiothérapie oncologique, Eldesoky, Ahmed R, Yates, Esben S, Nyeng, Tine B, Thomsen, Mette S, Nielsen, Hanne M, Poortmans, Philip, Kirkove, Carine, Krause, Mechthild, Kamby, Claus, Mjaaland, Ingvil, Blix, Egil S, Jensen, Ingelise, Berg, Martin, Lorenzen, Ebbe L, Taheri-Kadkhoda, Zahra, Offersen, Birgitte V, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service de radiothérapie oncologique, Eldesoky, Ahmed R, Yates, Esben S, Nyeng, Tine B, Thomsen, Mette S, Nielsen, Hanne M, Poortmans, Philip, Kirkove, Carine, Krause, Mechthild, Kamby, Claus, Mjaaland, Ingvil, Blix, Egil S, Jensen, Ingelise, Berg, Martin, Lorenzen, Ebbe L, Taheri-Kadkhoda, Zahra, and Offersen, Birgitte V

Abstract

BACKGROUND AND PURPOSE: To internally and externally validate an atlas based automated segmentation (ABAS) in loco-regional radiation therapy of breast cancer. MATERIALS AND METHODS: Structures of 60 patients delineated according to the ESTRO consensus guideline were included in four categorized multi-atlas libraries using MIM Maestro™ software. These libraries were used for auto-segmentation in two different patient groups (50 patients from the local institution and 40 patients from other institutions). Dice Similarity Coefficient, Average Hausdorff Distance, difference in volume and time were computed to compare ABAS before and after correction against a gold standard manual segmentation (MS). RESULTS: ABAS reduced the time of MS before and after correction by 93% and 32%, respectively. ABAS showed high agreement for lung, heart, breast and humeral head, moderate agreement for chest wall and axillary nodal levels and poor agreement for interpectoral, internal mammary nodal regions and LADCA. Correcting ABAS significantly improved all the results. External validation of ABAS showed comparable results. CONCLUSIONS: ABAS is a clinically useful tool for segmenting structures in breast cancer loco-regional radiation therapy in a multi-institutional setting. However, manual correction of some structures is important before clinical use. The ABAS is now available for routine clinical use in Danish patients.

Published
2016

18. Post-mastectomy radiotherapy in Denmark: from 2D to 3D treatment planning guidelines of The Danish Breast Cancer Cooperative Group

Author

Thomsen, Mette S, Berg, Martin, Nielsen, Hanne M, Pedersen, Aanders N, Overgaard, Marie, Ewertz, Marianne, Block, Thomas, Brodersen, Hans J, Caldera, Claudio, Jakobsen, Erik, Kamby, Claus, Kjaer-Kristoffersen, Flemming, Klitgaard, Dorte, Møller Nielsen, Mette, Stenbygaard, Lars, Zimmermann, Sune J, Grau, Cai, and Breast Cancer Cooperative Group, Danish

Subjects
medicine.medical_specialty, medicine.medical_treatment, Denmark, Breast Neoplasms, Mastectomy, Segmental, Danish, Breast cancer, medicine, Cooperative group, Combined Modality Therapy, Humans, Radiology, Nuclear Medicine and imaging, Medical physics, Breast, Radiation treatment planning, Lung, business.industry, Radiotherapy Planning, Computer-Assisted, Heart, Radiotherapy Dosage, Hematology, General Medicine, medicine.disease, language.human_language, Radiation therapy, Oncology, Lymphatic Metastasis, Practice Guidelines as Topic, language, Female, business, Post mastectomy radiotherapy, Mastectomy
Abstract

Udgivelsesdato: 2008 This paper describes the procedure of changing from 2D to 3D treatment planning guidelines for post-mastectomy radiotherapy in Denmark. The aim of introducing 3D planning for post-mastectomy radiotherapy was to optimize the target coverage and minimize the dose to the normal tissues. Initially, it was investigated whether it was possible to find a treatment technique alternative to the one recommended by the Danish Breast Cancer Cooperative Group (DBCG). A dosimetric comparison of a combined photon/electron 3-field technique (3F) and a partial wide tangent technique (PWT) was carried out on individual planning CT-scans from seven patients selected to represent a wide range of sizes and shapes of chest walls. The heart dose was lower for PWT than for 3F, however, for both techniques the dose was within the accepted constraints. The lung dose was higher but acceptable for six of the seven patients with PWT. The dose to the internal mammary nodes (IMN) was not satisfactory for five of the seven patients for 3F, whereas only two of the seven patients had a minimum dose lower than 95% of the prescribed dose with PWT. Finally, the dose to the contralateral breast was increased when using PWT compared to 3F. It was concluded that PWT was an appropriate choice of technique for future radiation treatment of post-mastectomy patients. A working group was formed and guidelines for 3D planning were developed during a series of workshops where radiation oncologists and physicists from all radiotherapy centres participated. This work also included a definition of the tissue structures needed to be outlined on the planning CT-scan. The work was initiated in 2003 and the guidelines were approved by the DBCG Radiotherapy Committee in 2006. The first of January 2007 the 3D guidelines had been fully implemented in five of the seven radiotherapy centres.

Published
2008
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19. The potential benefits from respiratory gating for breast cancer patients regarding target coverage and dose to organs at risk when applying strict dose limits to the heart: results from the DBCG HYPO trial.

Author

Berg, Martin, Lorenzen, Ebbe L., Jensen, Ingelise, Thomsen, Mette S., Lutz, Christina Maria, Refsgaard, Lasse, Nissen, Henrik D., and Offersen, Birgitte V.

Subjects
BREAST tumors, CANCER patients, MEDICAL cooperation, RADIATION doses, RADIOTHERAPY, RESEARCH, STATISTICAL sampling, RETROSPECTIVE studies, DESCRIPTIVE statistics
Abstract

Purpose:The potential benefits from respiratory gating (RG) compared to free-breathing (FB) regarding target coverage and dose to organs at risk for breast cancer patients receiving post-operative radiotherapy (RT) in the DBCG HYPO multicentre trial are reported. Material and methods:Patients included in the DBCG HYPO trial were randomized between 50 Gy in 25 fractions (normofractionated) versus 40 Gy in 15 fractions (hypofractionated). A tangential forward field-in-field dose planning technique was used to cover the clinical target volume (CTV) with the intent to limit dose to the left anterior descending coronary artery (LADCA) to 20 Gy and 17 Gy in the normo- and hypofractionated arms, respectively. Treatment plan data for 1327 patients from four Danish centres was retrospectively analyzed. FB right-sided patients served as control group for the left-sided patients regarding CTV V95%(relative volume receiving at least 95% of the prescribed dose), mean heart dose (MHD) and mean lung dose (MLD). Results:Median CTV V95%was for FB right-sided, FB left-sided and RG left-sided patients 94.6, 92.6 and 94.7% for normofractionated therapy, respectively, and 94.6, 91.8 and 94.4% for hypofractionated therapy and did not differ significantly for RG left-sided plans compared to FB right-sided in either study arm. CTV V95%was significantly lower for FB versus RG for left-sided plans in both arms. Median MHD was 0.7, 1.8 and 1.5 Gy (normofractionated therapy) versus 0.6, 1.5 and 1.2 Gy (hypofractionated therapy), respectively. The corresponding median MLD was 9.0, 8.3 and 7.3 Gy versus 7.3, 6.4 and 5.8 Gy, respectively. Conclusions:RG for left-sided breast cancer patients ensured similar CTV V95%as for FB right-sided patients. MLD was lower for RG due to the increased lung volume. MHD was generally low due to strict protocol-defined maximum dose to LADCA, but for left-sided patients RG led to significantly lower MHD. [ABSTRACT FROM PUBLISHER]

Published
2018
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21. Post-mastectomy radiotherapy in Denmark: From 2D to 3D treatment planning guidelines of The Danish Breast Cancer Cooperative Group

Author

Thomsen, Mette S., primary, Berg, Martin, additional, Nielsen, Hanne M., additional, Pedersen, Aanders N., additional, Overgaard, Marie, additional, Ewertz, Marianne, additional, Block, Thomas, additional, Brodersen, Hans J., additional, Caldera, Claudio, additional, Jakobsen, Erik, additional, Kamby, Claus, additional, Kjær-Kristoffersen, Flemming, additional, Klitgaard, Dorte, additional, Nielsen, Mette M., additional, Stenbygaard, Lars, additional, Zimmermann, Sune J., additional, and Grau, Cai, additional

Published
2008
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22. CT-planned internal mammary node radiotherapy in the DBCG-IMN study: Benefit versus potentially harmful effects.

Author

Thorsen, Lise B. J., Thomsen, Mette S., Berg, Martin, Jensen, Ingelise, Josipovic, Mirjana, Overgaard, Marie, Overgaard, Jens, Skogholt, Peter, and Offersen, Birgitte V.

Subjects
*ALGORITHMS, *BREAST tumors, *COMPUTED tomography, *CONFIDENCE intervals, *HEART, *LYMPH nodes, *RADIATION doses, *INTERVENTIONAL radiology, *RADIOTHERAPY, *RESEARCH funding, *T-test (Statistics)
Abstract

Background. The DBCG-IMN is a nationwide population-based cohort study on the effect of internal mammary node radiotherapy (IMN-RT) in patients with node positive early breast cancer. Due to the risk of RT-induced heart disease, only patients with right-sided breast cancer received IMN-RT, whereas patients with left-sided breast cancer did not. At seven-year median follow-up, a 3% gain in overall survival with IMN-RT has been reported. This study estimates IMN doses and doses to organs at risk (OAR) in patients from the DBCG-IMN. Numbers needed to harm (NNH) if patients with left-sided breast cancer had received IMN-RT are compared to the number needed to treat (NNT). Material and methods. Ten percent of CT-guided treatment plans from the DBCG-IMN patients were selected randomly. IMNs and OAR were contoured in 68 planning CT scans. Dose distributions were re-calculated. IMNs and OAR dose estimates were compared in right-sided versus left-sided breast cancer patients. In six left-sided patients, IMN-RT was simulated, and OAR doses were compared to those in the original plan. The NNH resulting from the change in mean heart dose (MHD) was calculated using a published model for risk of RT-related ischemic heart death. Results. In original plans, the absolute difference between right- and left-sided V90% to the IMNs was 38.0% [95% confidence interval (5.5%; 70.5%), p < 0.05]. Heart doses were higher in left-sided plans. With IMN-RT simulation without regard to OAR constraints, MHD increased 4.8 Gy (0.9 Gy; 8.7 Gy), p < 0.05. Resulting NNHs from ischemic heart death were consistently larger than the NNT with IMN-RT. Conclusion. Refraining from IMN-RT on the left side may have spared some ischemic heart deaths. Assuming left-sided patients benefit as much from IMN-RT as right-sided patients, the benefits from IMN-RT outweigh the costs in terms of ischemic heart death. [ABSTRACT FROM AUTHOR]

Published
2014
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24. Quality assurance of conventional non-CT-based internal mammary lymph node irradiation in a prospective Danish Breast Cancer Cooperative Group trial: The DBCG-IMN study.

Author

Thorsen, Lise B. J., Thomsen, Mette S., Overgaard, Marie, Overgaard, Jens, and Offersen, Birgitte V.

Subjects
*BREAST tumors, *CONFIDENCE intervals, *LONGITUDINAL method, *LYMPH nodes, *COMPUTERS in medicine, *QUALITY assurance, *RADIATION doses, *RADIOTHERAPY, *RESEARCH funding, *T-test (Statistics), *TOMOGRAPHY, *DESCRIPTIVE statistics
Abstract

In 2003, the Danish Breast Cancer Cooperative Group (DBCG) initiated DBCG-IMN, a prospective study on the effect of adjuvant internal mammary lymph node radiotherapy (IMN-RT) in patients with early lymph node positive breast cancer (BC). In the study, standard DBCG IMN-RT was provided only to patients with right-sided BC. We provide estimates of doses to IMNs and organs at risk (OARs) in patients treated with the non-CT-based RT techniques used during the DBCG-IMN study. Material and methods. Five DBCG RT regimens were simulated on planning CT scans from 50 consecutively scanned BC patients, 10 in each group. Intended target volumes were chest wall or breast and regional lymph nodes ± IMNs. Field planning was conducted in the EclipseTM RT treatment planning system. Subsequently, IMN clinical target volumes (CTVs) and OARs were delineated. Estimates on doses to the IMN-CTV and OARs were made. Results. IMN dose coverage estimates were consistently higher in right-sided techniques where IMN treatment was intended (p < 0.0001). Estimated doses to cardiac structures were low regardless of whether IMNs were treated or not. Post-lumpectomy patients had the highest estimated lung doses. Conclusion. Overall, simulator-based treatment using the DBCG RT techniques resulted in satisfactory coverage of IMNs and acceptable levels of OAR irradiation. [ABSTRACT FROM AUTHOR]

Published
2013
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25. Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: National guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group.

Author

Nielsen, Mette H., Berg, Martin, Pedersen, Anders N., Andersen, Karen, Glavicic, Vladimir, Jakobsen, Erik H., Jensen, Ingelise, Josipovic, Mirjana, Lorenzen, Ebbe L., Nielsen, Hanne M., Stenbygaard, Lars, Thomsen, Mette S., Vallentin, Susanne, Zimmermann, Sune, and Offersen, Birgitte V.

Subjects
MAMMOGRAMS, TOMOGRAPHY, BREAST tumors, MEDICAL protocols, RADIOTHERAPY
Abstract

During the past decade planning of adjuvant radiotherapy (RT) of early breast cancer has changed from two-dimensional (2D) to 3D conformal techniques. In the planning computerised tomography (CT) scan both the targets for RT and the organs at risk (OARs) are visualised, enabling an increased focus on target dose coverage and homogeneity with only minimal dose to the OARs. To ensure uniform RT in the national prospective trials of the Danish Breast Cancer Cooperative Group (DBCG), a national consensus for the delineation of clinical target volumes (CTVs) and OARs was required. Material and methods. A CT scan of a breast cancer patient after surgical breast conservation and axillary lymph node (LN) dissection was used for delineation. During multiple dummy-runs seven experienced radiation oncologists contoured all CTVs and OARs of interest in adjuvant breast RT. Two meetings were held in the DBCG Radiotherapy Committee to discuss the contouring and to approve a final consensus. The Dice similarity coefficient (DSC) was used to evaluate the delineation agreement before and after the consensus. Results. The consensus delineations of CTVs and OARs are available online and a table is presented with a contouring description of the individual volumes. The consensus provides recommendations for target delineation in a standard patient both in case of breast conservation or mastectomy. Before the consensus, the average value of the DSC was modest for most volumes, but high for the breast CTV and the heart. After the consensus, the DSC increased for all volumes. Conclusion. The DBCG has provided the first national guidelines and a contouring atlas of CTVs and OARs definition for RT of early breast cancer. The DSC is a useful tool in quantifying the effect of the introduction of guidelines indicating improved inter-delineator agreement. This consensus will be used by the DBCG in our prospective trials. [ABSTRACT FROM AUTHOR]

Published
2013
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