Radiat Oncol J.
2024 Dec;42(4):308-318. 10.3857/roj.2024.00248.
Radiation therapy volumes after primary systemic therapy in breast cancer patients: an international EUBREAST survey
- Gasparri ML
1,2,3 - Kaidar-Person O4,5
- Gentilini OD6,7
- de Boniface J8,9
- Kuehn T10
- Poortmans P11,12
- Affiliations
-
- 1Centro di Senologia della Svizzera Italiana, Ospedale Regionale di Lugano, Lugano, Switzerland
- 2Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Centro di Senologia della Svizzera Italiana, Lugano, Switzerland
- 3Faculty of Biomedicine, University of the Italian Switzerland, Lugano, Switzerland
- 4Tel Aviv University, Tel Aviv, Israel
- 5Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel
- 6IRCCS Ospedale San Raffaele, Milano, Italy
- 7Università Vita-Salute San Raffaele, Milano, Italy
- 8Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- 9Department of Surgery, Breast Centre, Capio St. Göran's Hospital, Stockholm, Sweden
- 10University of Ulm, Die Filderklinik, Germany
- 11Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium
- 12University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
- KMID: 2562875
- DOI: http://doi.org/10.3857/roj.2024.00248
Abstract
- Purpose
After primary systemic therapy (PST), agreement on the extent of locoregional therapy is lacking in breast cancer patients who convert from a node-positive to a node-negative status. The aim of this survey was to investigate radiation therapy approaches after PST according to different axillary surgical strategies and disease responses. Material and Methods: The European Breast Cancer Research Association of Surgical Trialists developed a web-based survey containing 39 questions on locoregional management based on clinical scenarios in initially node positive breast cancer patients undergoing PST. Twelve international breast cancer societies distributed the link to breast surgeons and radiation oncologists.
Results
Responses from 349 breast specialists were recorded, 72 of whom (20.6%) were radiation oncologists from 17 countries. Nodal status at diagnosis informed the decision for postoperative regional nodal irradiation (RNI) for 44/72 (61.1%) responders. RNI in node positive patients having undergone axillary lymph node dissection (ALND) is delivered in selected cases by 30/72 (41.7%) responders and systemically recommended by 26/72 (36.1%) responders. In case of macrometastases found on ALND, 43/72 (59.7%) responders always deliver RNI. In case of micrometastases in the sentinel lymph node(s) or targeted lymph node(s), 45/72 (62.5%) responders prefer RNI to completion ALND. A majority of responders (59.7%) determine the target volume for RNI according to European Society for Radiotherapy and Oncology guidelines. Significant heterogeneity was observed regarding nodal basins and volumes of interest for dose coverage by RNI.
Conclusions
There is significant heterogeneity in radiation-therapy delivered to the axilla after PST. A more standardized approach engaging both radiation oncologists and breast surgeons will help to optimize the harm-benefit equilibrium of axillary surgery and RNI.
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