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Abstract
The purpose of the current in silico planning study is to compare radiation doses of whole-breast irradiation (WBI) and whole-breast plus regional lymph node irradiation (WBI+RNI) administered to the regional lymph nodes (RLN) in pN1 breast cancer. Twenty-four participating institutions were asked to create plans of WBI and WBI+RNI for two dummy cases. To compare target coverage between the participants, an isodose line equal to 90% of the prescribed dose was converted to an isodose contour (contour90% iso). The relative nodal dose (RND) was obtained using the ratio of RLN dose to the target dose. The Fleiss's kappa values which represent inter-observer agreement of contour90% iso were over 0.68. For RNI, 6 institutions included axillary lymph node (ALN), supraclavicular lymph node (SCN), and internal mammary lymph node (IMN), while 18 hospitals included only ALN and SCN. The median RND between the WBI and WBI+RNI were as follows: 0.64 vs. 1.05 (ALN level I), 0.27 vs. 1.08 (ALN level II), 0.02 vs. 1.12 (ALN level III), 0.01 vs. 1.12 (SCN), and 0.54 vs. 0.82 (IMN). In all nodal regions, the RND was significantly lower in WBI than in WBI+RNI (p < 0.01). In this study, we could identify the nodal dose difference between WBI and WBI+RNI.

Affiliations

Haeyoung Kim  1 , Heejung Kim  1 , Won Park  1 , Jong Yun Baek  1 , Sung Ja Ahn  2 , Mi Young Kim  3 , Shin-Hyung Park  4 , Ik Jae Lee  5 , Inbong Ha  6 , Jin Hee Kim  7 , Tae Hyun Kim  8 , Kyu Chan Lee  9 , Hyung-Sik Lee  10 , Tae Gyu Kim  11 , Jin Ho Kim  12 , Jong Hoon Lee  13 , Jinhong Jung  14 , Oyeon Cho  15 , Jee Suk Chang  16 , Eun Seog Kim  17 , In Young Jo  17 , Taeryool Koo  18 , Kyubo Kim  19 , Hae Jin Park  20 , Young-Joo Shin  21 , Boram Ha  22 , Jeanny Kwon  23 , Ju Hye Lee  24 , Sunrock Moon  25
1 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
2 Department of Radiation Oncology, Chonnam National University Medical School, Gwangju 58128, Korea.
3 Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea.
4 Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu 41944, Korea.
5 Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
6 Department of Radiation Oncology, Gyengsang National University Hospital, Gyengsang National University School of Medicine, Jinju 52727, Korea.
7 Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu 41931, Korea.
8 National Cancer Center, Research Institute and Hospital, Center for Proton Therapy, Goyang 10408, Korea.
9 Department of Radiation Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea.
10 Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan 49201, Korea.
11 Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea.
12 Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Korea.
13 Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea, Suwon 16247, Korea.
14 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
15 Department of Radiation Oncology, Ajou University School of Medicine, Suwon 16499, Korea.
16 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 03722, Korea.
17 Department of Radiation Oncology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Cheonan 31151, Korea.
18 Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea.
19 Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul 07804, Korea.
20 Department of Radiation Oncology, Hanyang University College of Medicine, Seoul 15588, Korea.
21 Department of Radiation Oncology, Inje University Sanggye Paik Hospital, Seoul 07804, Korea.
22 Department of Radiation Oncology, Hallylm University Dongtan Sacred Heart Hospital, Hwaseong 14068, Korea.
23 Department of Radiation Oncology, Chungnam National University Hospital, Daejeon 35015, Korea.
24 Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea.
25 Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan 54538, Korea.