Y Belkacemi1, O Kaidar-Person2, P Poortmans3, M Ozsahin4, M-C Valli5, N Russell6, I Kunkler7, J Hermans8, A Kuten9, G van Tienhoven10, H Westenberg11. 1. APHP, GH Henri Mondor Breast Center, Radiation Oncology Department, University Paris-East Creteil, France Association of Radiotherapy and Oncology of the Mediterranean Area (www.aromecancer.org) yazid.belkacemi@hmn.aphp.fr. 2. Association of Radiotherapy and Oncology of the Mediterranean Area (www.aromecancer.org) Department of Radiation Oncology, Rambam, Haifa, Israel. 3. Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands. 4. Association of Radiotherapy and Oncology of the Mediterranean Area (www.aromecancer.org) Department of Radiation Oncology, CHUV, Lausanne. 5. Radiation Oncology Department, Oncology Institute of Southern Switzerland, Switzerland. 6. Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 7. Edinburgh Cancer Centre, University of Edinburgh, Edinburgh, UK. 8. EORTC Breast Working Party of the Radiation Oncology Group (ROG), EORTC, Brussels, Belgium. 9. Association of Radiotherapy and Oncology of the Mediterranean Area (www.aromecancer.org) Department of Radiation Oncology, Rambam, Haifa, Israel Italian Hospital, Haifa, Israel. 10. Department of Radiation Oncology, Academisch Medisch Centrum, Amsterdam. 11. Institute for Radiation Oncology Arnhem (ARTI), Arnhem, The Netherlands.
Abstract
BACKGROUND: Predicting outcome of breast cancer (BC) patients based on sentinel lymph node (SLN) status without axillary lymph node dissection (ALND) is an area of uncertainty. It influences the decision-making for regional nodal irradiation (RNI). The aim of the NORA (NOdal RAdiotherapy) survey was to examine the patterns of RNI. METHODS: A web-questionnaire, including several clinical scenarios, was distributed to 88 EORTC-affiliated centers. Responses were received between July 2013 and January 2014. RESULTS: A total of 84 responses were analyzed. While three-dimensional (3D) radiotherapy (RT) planning is carried out in 81 (96%) centers, nodal areas are delineated in only 51 (61%) centers. Only 14 (17%) centers routinely link internal mammary chain (IMC) and supraclavicular node (SCN) RT indications. In patients undergoing total mastectomy (TM) with ALND, SCN-RT is recommend by 5 (6%), 53 (63%) and 51 (61%) centers for patients with pN0(i+), pN(mi) and pN1, respectively. Extra-capsular extension (ECE) is the main factor influencing decision-making RNI after breast conserving surgery (BCS) and TM. After primary systemic therapy (PST), 49 (58%) centers take into account nodal fibrotic changes in ypN0 patients for RNI indications. In ypN0 patients with inner/central tumors, 23 (27%) centers indicate SCN-RT and IMC-RT. In ypN1 patients, SCN-RT is delivered by less than half of the centers in patients with ypN(i+) and ypN(mi). Twenty-one (25%) of the centers recommend ALN-RT in patients with ypN(mi) or 1-2N+ after ALND. Seventy-five (90%) centers state that age is not considered a limiting factor for RNI. CONCLUSION: The NORA survey is unique in evaluating the impact of SLNB/ALND status on adjuvant RNI decision-making and volumes after BCS/TM with or without PST. ALN-RT is often indicated in pN1 patients, particularly in the case of ECE. Besides the ongoing NSABP-B51/RTOG and ALLIANCE trials, NORA could help to design future specific RNI trials in the SLNB era without ALND in patients receiving or not PST.
BACKGROUND: Predicting outcome of breast cancer (BC) patients based on sentinel lymph node (SLN) status without axillary lymph node dissection (ALND) is an area of uncertainty. It influences the decision-making for regional nodal irradiation (RNI). The aim of the NORA (NOdal RAdiotherapy) survey was to examine the patterns of RNI. METHODS: A web-questionnaire, including several clinical scenarios, was distributed to 88 EORTC-affiliated centers. Responses were received between July 2013 and January 2014. RESULTS: A total of 84 responses were analyzed. While three-dimensional (3D) radiotherapy (RT) planning is carried out in 81 (96%) centers, nodal areas are delineated in only 51 (61%) centers. Only 14 (17%) centers routinely link internal mammary chain (IMC) and supraclavicular node (SCN) RT indications. In patients undergoing total mastectomy (TM) with ALND, SCN-RT is recommend by 5 (6%), 53 (63%) and 51 (61%) centers for patients with pN0(i+), pN(mi) and pN1, respectively. Extra-capsular extension (ECE) is the main factor influencing decision-making RNI after breast conserving surgery (BCS) and TM. After primary systemic therapy (PST), 49 (58%) centers take into account nodal fibrotic changes in ypN0 patients for RNI indications. In ypN0 patients with inner/central tumors, 23 (27%) centers indicate SCN-RT and IMC-RT. In ypN1 patients, SCN-RT is delivered by less than half of the centers in patients with ypN(i+) and ypN(mi). Twenty-one (25%) of the centers recommend ALN-RT in patients with ypN(mi) or 1-2N+ after ALND. Seventy-five (90%) centers state that age is not considered a limiting factor for RNI. CONCLUSION: The NORA survey is unique in evaluating the impact of SLNB/ALND status on adjuvant RNI decision-making and volumes after BCS/TM with or without PST. ALN-RT is often indicated in pN1patients, particularly in the case of ECE. Besides the ongoing NSABP-B51/RTOG and ALLIANCE trials, NORA could help to design future specific RNI trials in the SLNB era without ALND in patients receiving or not PST.
Authors: Sang-Won Kim; Doo Ho Choi; Seung Jae Huh; Won Park; Seok Jin Nam; Seok Won Kim; Jeong Eon Lee; Young-Hyuck Im; Jin Seok Ahn; Yeon Hee Park Journal: J Breast Cancer Date: 2016-06-24 Impact factor: 3.588
Authors: Charlotte E Coles; Clare L Griffin; Anna M Kirby; Jenny Titley; Rajiv K Agrawal; Abdulla Alhasso; Indrani S Bhattacharya; Adrian M Brunt; Laura Ciurlionis; Charlie Chan; Ellen M Donovan; Marie A Emson; Adrian N Harnett; Joanne S Haviland; Penelope Hopwood; Monica L Jefford; Ronald Kaggwa; Elinor J Sawyer; Isabel Syndikus; Yat M Tsang; Duncan A Wheatley; Maggie Wilcox; John R Yarnold; Judith M Bliss Journal: Lancet Date: 2017-08-02 Impact factor: 79.321