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Abstract

BACKGROUND AND PURPOSE:

To validate the ESTRO guideline on clinical target volume (CTV) delineation for breast cancer using a multi-centre dataset.

MATERIALS AND METHODS:

Patients with axial imaging of gross locoregional recurrence (LRR) were identified from 10 participating institutions. All patients received RT, albeit not to all regional node. The location of LRR was transferred to the corresponding area on representative axial computed tomography images and compared with ESTRO-CTV.

RESULTS:

The locations of LRRs in 234 patients with 337 recurrence lesions were mapped. The ESTRO-CTV encompassed 97.6% of all LRRs, except in lymph node level 4 and the pectoralis muscle. Although 8.8% of level 4 failures occurred outside the ESTRO-CTV, cranial to the subclavian artery, all nodes were located within 6 mm cranially. Another 20% occurred posterolateral to anterior scalene muscles; however, 11/16 cases had simultaneous multiple lymph node recurrences, and 8/16 initially had N2-3 tumours. Local recurrence at the pectoralis muscle was prominent in patients undergoing mastectomy but not breast-conservation surgery (28% vs. 2.9%, P = .001).

CONCLUSIONS:

Our mapping data demonstrated that the ESTRO-CTV, with some considerations, successfully encompassed most LRRs in patients undergoing contemporary management, thus validating ESTRO-CTV to be valuable for highly conformal radiation therapy techniques.​

Fig. 1. Overview of locoregional recurrence locations on the anteroposterior (AP) view, in relation to the European Society for Radiotherapy and Oncology (ESTRO)-clinical target volume (CTV; blue) and the Radiation Therapy Oncology Group (RTOG)-CTV. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)​  

Author information

Chang JS1, Lee J2, Chun M3, Shin KH4, Park W5, Lee JH6, Kim JH7, Yoon WS8, Lee IJ9, Kim J10, Park HL11, Kim YB12.

1 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.

2 Department of Radiation Oncology, Inha University Hospital, Incheon, Republic of Korea.

3 Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.

4 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.

5 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

6 Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea.

7 Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.

8 Department of Radiation Oncology, Ansan Hospital, Korea University Medical Center, Ansan, Republic of Korea.

9 Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

10 Department of Radiation Oncology, Cheil General Hospital, Dankook University College of Medicine, Seoul, Republic of Korea.

11 Department of Radiation Oncology, Presbyterian Medical Center, Jeonju, Republic of Korea.

12 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: ybkim3@yuhs.ac.