Birgitte V Offersen1, Liesbeth J Boersma2, Carine Kirkove3, Sandra Hol4, Marianne C Aznar5, Albert Biete Sola6, Youlia M Kirova7, Jean-Philippe Pignol8, Vincent Remouchamps9, Karolien Verhoeven10, Caroline Weltens10, Meritxell Arenas11, Dorota Gabrys12, Neil Kopek13, Mechthild Krause14, Dan Lundstedt15, Tanja Marinko16, Angel Montero17, John Yarnold18, Philip Poortmans19. 1. Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: birgoffe@rm.dk. 2. Department of Radiation Oncology, Maastricht University Medical Centre - GROW (MAASTRO), The Netherlands. 3. Department of Radiation Oncology, Catholic University of Louvain, Belgium. 4. Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands. 5. Department of Oncology, Rigshospitalet, Copenhagen, Denmark. 6. Department of Radiation Oncology, Hospital Clinic i Provincial, Barcelona, Spain. 7. Department of Radiation Oncology, Institut Curie, Paris, France. 8. Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands. 9. Department of Radiation Oncology, Clinique Sainte Elisabeth (AMPR), Namur, Belgium. 10. Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium. 11. Department of Radiation Oncology, Hospital Universitari Sant Joan, Reus, Spain. 12. Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice, Poland. 13. Department of Oncology, Division of Radiation Oncology, McGill University, Montréal, Canada. 14. German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ) Heidelberg, Dept. of Radiation Oncology and OncoRay, University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany. 15. Department of Oncology, Sahlgrenska Universitetssjukhuset, Gothenborg, Sweden. 16. Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia. 17. Department of Radiation Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario Sanchinarro, Madrid, Spain. 18. Division of Radiotherapy and Imaging, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK. 19. Department of Radiation Oncology, Radboud university medical centre, The Netherlands.
Abstract
BACKGROUND AND PURPOSE: Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. MATERIAL AND METHODS: During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. RESULTS: Borders of the CTV encompassing a 5mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. CONCLUSION: The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency.
BACKGROUND AND PURPOSE: Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancerpatients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. MATERIAL AND METHODS: During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. RESULTS: Borders of the CTV encompassing a 5mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. CONCLUSION: The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency.
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