%0 Journal Article
%T Quality assessment of radiotherapy in the prospective randomized SENOMAC trial.
%A Alkner S
%A Wieslander E
%A Lundstedt D
%A Berg M
%A Kristensen I
%A Andersson Y
%A Bergkvist L
%A Frisell J
%A Olofsson Bagge R
%A Sund M
%A Christiansen P
%A Davide Gentilini O
%A Kontos M
%A Kühn T
%A Reimer T
%A Rydén L
%A Filtenborg Tvedskov T
%A Vrou Offersen B
%A Dahl Nissen H
%A de Boniface J
%A
%J Radiother Oncol
%V 197
%N 0
%D 2024 08 10
%M 38866204
%F 6.901
%R 10.1016/j.radonc.2024.110372
%X 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.