Patterns of practice of regional nodal irradiation in breast cancer: results of the European Organization for Research and Treatment of Cancer (EORTC) NOdal Radiotherapy (NORA) survey

被引：31
作者：
Belkacemi, Y. [1 ,2 ]
Kaidar-Person, O. [2 ,3 ]
Poortmans, P. [4 ]
Ozsahin, M. [2 ,5 ]
Valli, M-C [6 ]
Russell, N. [7 ]
Kunkler, I. [8 ]
Hermans, J. [9 ]
Kuten, A. [2 ,3 ,10 ]
van Tienhoven, G. [11 ]
Westenberg, H. [12 ]
机构：
[1] Univ Paris East Creteil, Dept Radiat Oncol, GH Henri Mondor Breast Ctr, APHP, Paris, France
[2] Assoc Radiotherapy & Oncol Mediterranean Area Www, Grenoble, France
[3] Rambam, Dept Radiat Oncol, Haifa, Israel
[4] Radboud Univ Nijmegen, Med Ctr, Dept Radiat Oncol, NL-6525 ED Nijmegen, Netherlands
[5] CHU Vaudois, Dept Radiat Oncol, Lausanne, Switzerland
[6] Oncol Inst Southern Switzerland, Dept Radiat Oncol, Basel, Switzerland
[7] Netherlands Canc Inst, Dept Radiotherapy, Amsterdam, Netherlands
[8] Univ Edinburgh, Edinburgh Canc Ctr, Edinburgh, Midlothian, Scotland
[9] EORTC, Radiat Oncol Grp ROG, EORTC Breast Working Party, Brussels, Belgium
[10] Italian Hosp, Haifa, Israel
[11] Univ Amsterdam, Acad Med Ctr, Dept Radiat Oncol, NL-1105 AZ Amsterdam, Netherlands
[12] Inst Radiat Oncol Arnhem ARTI, Arnhem, Netherlands
来源：
ANNALS OF ONCOLOGY | 2015年 / 26卷 / 03期
关键词：
radiotherapy; breast cancer; sentinel lymph node; axillary dissection; internal mammary chain; supraclavicular node; RANDOMIZED-TRIALS; CLINICAL-PRACTICE; DOSE DISTRIBUTION; POSITIVE NODES; SENTINEL NODE; GUIDELINES; ONCOLOGY; SOCIETY; WOMEN; AREA;
D O I：
10.1093/annonc/mdu561
中图分类号：
R73 [肿瘤学];
学科分类号：
100214 ;
摘要：
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.
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收藏
页码：529 / 535
页数：7
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