{Reference Type}: Journal Article
{Title}: Quality assessment of radiotherapy in the prospective randomized SENOMAC trial.
{Author}: Alkner S;Wieslander E;Lundstedt D;Berg M;Kristensen I;Andersson Y;Bergkvist L;Frisell J;Olofsson Bagge R;Sund M;Christiansen P;Davide Gentilini O;Kontos M;Kühn T;Reimer T;Rydén L;Filtenborg Tvedskov T;Vrou Offersen B;Dahl Nissen H;de Boniface J; ;
{Journal}: Radiother Oncol
{Volume}: 197
{Issue}: 0
{Year}: 2024 08 10
{Factor}: 6.901
{DOI}: 10.1016/j.radonc.2024.110372
{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.