Abstract：
Recommendations for regional radiotherapy (RT) of sentinel lymph node (SLN)-positive breast cancer are debated. We here report a RT quality assessment of the SENOMAC trial.
The SENOMAC trial randomized clinically node-negative breast cancer patients with 1-2 SLN macrometastases to completion axillary lymph node dissection (cALND) or SLN biopsy only between 2015-2021. Adjuvant RT followed national guidelines. RT plans for patients included in Sweden and Denmark until June 2019 were collected (N = 1176) and compared to case report forms (CRF). Dose to level I (N = 270) and the humeral head (N = 321) was analyzed in detail.
CRF-data and RT plans agreed in 99.3 % (breast/chest wall) and in 96.6 % of patients (regional RT). Congruence for whether level I was an intended RT target was lower (78 %). In accordance with Danish national guidelines, level I was more often an intended target in the SLN biopsy only arm (N = 334/611, 55 %,) than in the cALND arm (N = 174/565, 31 %,). When an intended target, level I received prescribed dose to 100 % (IQR 98-100 %) of the volume. However, even when not an intended target, full dose was delivered to > 80 % of level I (IQR 75-90 %). The intentional inclusion of level I in the target volume more than doubled the dose received by ≥ 50 % of the humeral head.
Congruence between CRF data and RT plans was excellent. Level I received a high dose coverage even when not intentionally included in the target. Including level I in target significantly increased dose to the humeral head.
The SENOMAC trial randomized clinically node-negative breast cancer patients with 1-2 SLN macrometastases to completion axillary lymph node dissection (cALND) or SLN biopsy only between 2015-2021. Adjuvant RT followed national guidelines. RT plans for patients included in Sweden and Denmark until June 2019 were collected (N = 1176) and compared to case report forms (CRF). Dose to level I (N = 270) and the humeral head (N = 321) was analyzed in detail.
CRF-data and RT plans agreed in 99.3 % (breast/chest wall) and in 96.6 % of patients (regional RT). Congruence for whether level I was an intended RT target was lower (78 %). In accordance with Danish national guidelines, level I was more often an intended target in the SLN biopsy only arm (N = 334/611, 55 %,) than in the cALND arm (N = 174/565, 31 %,). When an intended target, level I received prescribed dose to 100 % (IQR 98-100 %) of the volume. However, even when not an intended target, full dose was delivered to > 80 % of level I (IQR 75-90 %). The intentional inclusion of level I in the target volume more than doubled the dose received by ≥ 50 % of the humeral head.
Congruence between CRF data and RT plans was excellent. Level I received a high dose coverage even when not intentionally included in the target. Including level I in target significantly increased dose to the humeral head.
摘要：
目的：对前哨淋巴结（SLN）阳性乳腺癌区域放疗（RT）的建议进行辩论。我们在此报告SENOMAC试验的RT质量评估。
方法：SENOMAC试验仅在2015年至2021年之间，将具有1-2个SLN大转移的临床淋巴结阴性乳腺癌患者随机分配到完成腋窝淋巴结清扫术（cALND）或SLN活检。辅助RT遵循国家指南。收集截至2019年6月在瑞典和丹麦纳入的患者的RT计划（N=1176），并与病例报告表（CRF）进行比较。详细分析了I级（N=270）和肱骨头（N=321）的剂量。
结果：CRF数据和RT计划在99.3％（乳房/胸壁）和96.6％（区域RT）的患者中达成一致。I级是否是预期RT目标的一致性较低(78%)。根据丹麦国家准则，I级通常是SLN活检组中的预期目标（N=334/611，55%，)比cALND臂(N=174/565，31%，).当一个预定的目标，I级接受处方剂量至体积的100%(IQR98-100%)。然而,即使不是预定目标，全剂量递送至>80%的I级(IQR75-90%)。在目标体积中有意包含I级，超过50％的肱骨头接受的剂量增加了一倍以上。
结论：CRF数据与RT计划的一致性非常好。即使没有有意地包括在目标中,水平I也接受高剂量覆盖。包括I级在内的目标显著增加到肱骨头的剂量。
方法：SENOMAC试验仅在2015年至2021年之间，将具有1-2个SLN大转移的临床淋巴结阴性乳腺癌患者随机分配到完成腋窝淋巴结清扫术（cALND）或SLN活检。辅助RT遵循国家指南。收集截至2019年6月在瑞典和丹麦纳入的患者的RT计划（N=1176），并与病例报告表（CRF）进行比较。详细分析了I级（N=270）和肱骨头（N=321）的剂量。
结果：CRF数据和RT计划在99.3％（乳房/胸壁）和96.6％（区域RT）的患者中达成一致。I级是否是预期RT目标的一致性较低(78%)。根据丹麦国家准则，I级通常是SLN活检组中的预期目标（N=334/611，55%，)比cALND臂(N=174/565，31%，).当一个预定的目标，I级接受处方剂量至体积的100%(IQR98-100%)。然而,即使不是预定目标，全剂量递送至>80%的I级(IQR75-90%)。在目标体积中有意包含I级，超过50％的肱骨头接受的剂量增加了一倍以上。
结论：CRF数据与RT计划的一致性非常好。即使没有有意地包括在目标中,水平I也接受高剂量覆盖。包括I级在内的目标显著增加到肱骨头的剂量。
