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Quality assessment of radiotherapy in the prospective randomized SENOMAC trial

Alkner, Sara LU ; Wieslander, Elinore LU ; Lundstedt, Dan ; Berg, Martin ; Kristensen, Ingrid ; Andersson, Yvette ; Bergkvist, Leif ; Frisell, Jan ; Olofsson Bagge, Roger LU and Sund, Malin , et al. (2024) In Radiotherapy and Oncology 197.
Abstract

Background and purpose: Recommendations for regional radiotherapy (RT) of sentinel lymph node (SLN)-positive breast cancer are debated. We here report a RT quality assessment of the SENOMAC trial. Materials and Methods: The SENOMAC trial randomized clinically node-negative breast cancer patients with 1–2 SLN macrometastases to completion axillary lymph node dissection (cALND) or SLN biopsy only between 2015–2021. Adjuvant RT followed national guidelines. RT plans for patients included in Sweden and Denmark until June 2019 were collected (N = 1176) and compared to case report forms (CRF). Dose to level I (N = 270) and the humeral head (N = 321) was analyzed in detail. Results: CRF-data and RT plans agreed in 99.3 % (breast/chest wall)... (More)

Background and purpose: Recommendations for regional radiotherapy (RT) of sentinel lymph node (SLN)-positive breast cancer are debated. We here report a RT quality assessment of the SENOMAC trial. Materials and Methods: The SENOMAC trial randomized clinically node-negative breast cancer patients with 1–2 SLN macrometastases to completion axillary lymph node dissection (cALND) or SLN biopsy only between 2015–2021. Adjuvant RT followed national guidelines. RT plans for patients included in Sweden and Denmark until June 2019 were collected (N = 1176) and compared to case report forms (CRF). Dose to level I (N = 270) and the humeral head (N = 321) was analyzed in detail. Results: CRF-data and RT plans agreed in 99.3 % (breast/chest wall) and in 96.6 % of patients (regional RT). Congruence for whether level I was an intended RT target was lower (78 %). In accordance with Danish national guidelines, level I was more often an intended target in the SLN biopsy only arm (N = 334/611, 55 %,) than in the cALND arm (N = 174/565, 31 %,). When an intended target, level I received prescribed dose to 100 % (IQR 98–100 %) of the volume. However, even when not an intended target, full dose was delivered to > 80 % of level I (IQR 75–90 %). The intentional inclusion of level I in the target volume more than doubled the dose received by ≥ 50 % of the humeral head. Conclusion: Congruence between CRF data and RT plans was excellent. Level I received a high dose coverage even when not intentionally included in the target. Including level I in target significantly increased dose to the humeral head.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
(omission of) sentinel lymph node biopsy, Axillary treatment, Breast cancer, Incidental radiotherapy dose, Radiotherapy quality assurance, Radiotherapy techniques, Treatment planning
in
Radiotherapy and Oncology
volume
197
article number
110372
publisher
Elsevier
external identifiers
  • scopus:85195674426
  • pmid:38866204
ISSN
0167-8140
DOI
10.1016/j.radonc.2024.110372
language
English
LU publication?
yes
id
3e634d65-e239-4de1-8b25-b97feca004df
date added to LUP
2024-07-02 14:42:05
date last changed
2024-07-02 14:43:33
@article{3e634d65-e239-4de1-8b25-b97feca004df,
  abstract     = {{<p>Background and purpose: Recommendations for regional radiotherapy (RT) of sentinel lymph node (SLN)-positive breast cancer are debated. We here report a RT quality assessment of the SENOMAC trial. Materials and Methods: The SENOMAC trial randomized clinically node-negative breast cancer patients with 1–2 SLN macrometastases to completion axillary lymph node dissection (cALND) or SLN biopsy only between 2015–2021. Adjuvant RT followed national guidelines. RT plans for patients included in Sweden and Denmark until June 2019 were collected (N = 1176) and compared to case report forms (CRF). Dose to level I (N = 270) and the humeral head (N = 321) was analyzed in detail. Results: CRF-data and RT plans agreed in 99.3 % (breast/chest wall) and in 96.6 % of patients (regional RT). Congruence for whether level I was an intended RT target was lower (78 %). In accordance with Danish national guidelines, level I was more often an intended target in the SLN biopsy only arm (N = 334/611, 55 %,) than in the cALND arm (N = 174/565, 31 %,). When an intended target, level I received prescribed dose to 100 % (IQR 98–100 %) of the volume. However, even when not an intended target, full dose was delivered to &gt; 80 % of level I (IQR 75–90 %). The intentional inclusion of level I in the target volume more than doubled the dose received by ≥ 50 % of the humeral head. Conclusion: Congruence between CRF data and RT plans was excellent. Level I received a high dose coverage even when not intentionally included in the target. Including level I in target significantly increased dose to the humeral head.</p>}},
  author       = {{Alkner, Sara and Wieslander, Elinore and Lundstedt, Dan and Berg, Martin and Kristensen, Ingrid and Andersson, Yvette and Bergkvist, Leif and Frisell, Jan and Olofsson Bagge, Roger and Sund, Malin and Christiansen, Peer and Davide Gentilini, Oreste and Kontos, Michalis and Kühn, Thorsten and Reimer, Toralf and Rydén, Lisa and Filtenborg Tvedskov, Tove and Vrou Offersen, Birgitte and Dahl Nissen, Henrik and de Boniface, Jana}},
  issn         = {{0167-8140}},
  keywords     = {{(omission of) sentinel lymph node biopsy; Axillary treatment; Breast cancer; Incidental radiotherapy dose; Radiotherapy quality assurance; Radiotherapy techniques; Treatment planning}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Radiotherapy and Oncology}},
  title        = {{Quality assessment of radiotherapy in the prospective randomized SENOMAC trial}},
  url          = {{http://dx.doi.org/10.1016/j.radonc.2024.110372}},
  doi          = {{10.1016/j.radonc.2024.110372}},
  volume       = {{197}},
  year         = {{2024}},
}