The dosimetric impact of axillary nodes contouring variability in breast cancer radiotherapy: An AIRO multi-institutional study.

Autor: Leonardi MC; Division of Radiation Oncology, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy., Pepa M; Division of Radiation Oncology, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy., Luraschi R; Unit of Medical Physics, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy., Vigorito S; Unit of Medical Physics, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy., Dicuonzo S; Division of Radiation Oncology, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy. Electronic address: samantha.dicuonzo@ieo.it., Isaksson LJ; Division of Radiation Oncology, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy., La Porta MR; Radiotherapy Department, ASL TO4 Ivrea Community Hospital, Ivrea, Italy., Marino L; Radiotherapy Unit, Viagrande, Italy., Ippolito E; Department of Radiotherapy, Campus Bio-Medico University, Roma, Italy., Huscher A; Radiotherapy Unit, Fondazione Poliambulanza, Brescia, Italy., Argenone A; Division of Radiation Oncology, Azienda Ospedaliera di Rilievo Nazionale San Pio, Benevento, Italy., De Rose F; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Centre IRCCS, Milano, Italy., Cucciarelli F; Radiotherapy Unit, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy., De Santis MC; Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milano, Italy., Rossi F; Radiotherapy Unit, Usl Toscana Centro, Ospedale Santa Maria Annunziata, Firenze, Italy., Prisco A; Department of Radiotherapy, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy., Guarnaccia R; Radiotherapy Unit, Ospedale Fatebenefratelli Isola Tiberina, Roma, Italy., Tabarelli de Fatis P; Medical Physics Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy., Palumbo I; Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy., Colangione SP; Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy., Mormile M; Unit of Medical Physics, ASL Napoli 1 Centro - Ospedale del Mare, Napoli, Italy., Ravo V; Unit of Radiotherapy, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy., Fozza A; Division of Radiation Oncology, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy., Aristei C; Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy., Orecchia R; Scientific Direction, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy., Cattani F; Unit of Medical Physics, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy., Jereczek-Fossa BA; Division of Radiation Oncology, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2022 Mar; Vol. 168, pp. 113-120. Date of Electronic Publication: 2022 Jan 13.
DOI: 10.1016/j.radonc.2022.01.004
Abstrakt: Aim: To quantify the dosimetric impact of contouring variability of axillary lymph nodes (L2, L3, L4) in breast cancer (BC) locoregional radiotherapy (RT).
Materials and Methods: 18 RT centres were asked to plan a locoregional treatment on their own planning target volume (single centre, SC-PTV) which was created by applying their institutional margins to the clinical target volume of the axillary nodes of three BC patients (P1, P2, P3) previously delineated (SC-CTV). The gold standard CTVs (GS-CTVs) of P1, P2 and P3 were developed by BC experts' consensus and validated with STAPLE algorithm. For each participating centre, the GS-PTV of each patient was created by applying the same margins as those used for the SC-CTV to SC-PTV expansion and replaced the SC-PTV in the treatment plan. Datasets were imported into MIM v6.1.7 [MIM Software Inc.], where dose-volume histograms (DVHs) were extracted and differences were analysed.
Results: 17/18 centres used intensity-modulated RT (IMRT). The CTV to PTV margins ranged from 0 to 10 mm (median 5 mm). No correlation was observed between GS-CTV coverage by 95% isodose and GS-PTV margins width. Doses delivered to 98% (D98) and 95% (D95) of GS-CTVs were significantly lower than those delivered to the SC-CTVs. No significant difference between SC-CTV and GS-CTV was observed in maximum dose (D2), always under 110%. Mean dose ≥99% of the SC-CTVs and GS-CTVs was satisfied in 84% and 50%, respectively. In less than one half of plans, GS-CTV V95% was above 90%. Breaking down the GS-CTV into the three nodal levels (L2, L3 and L4), L4 had the lowest probability to be covered by the 95% isodose.
Conclusions: Overall, GS-CTV resulted worse coverage, especially for L4. IMRT was largely used and CTV-to-PTV margins did not compensate for contouring issues. The results highlighted the need for delineation training and standardization.
Competing Interests: Conflict of interest statement MCL and FC received honorarium fee from Accuray Inc. outside the current article. BAJF reports personal fees from Janssen, Ferring, Bayer, Roche, Astellas, Elekta, Carl Zeiss, Ipsen, IBA, grants and personal fees from Accuray, grants from AIRC and FIEO-CCM & FUV, all outside the current paper. The remaining authors declared no conflict of interest.
(Copyright © 2022 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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