Comparison of dose distribution in regional lymph nodes in whole-breast radiotherapy vs. Whole-breast plus regional lymph node irradiation: An in silico planning study in participating institutions of the phase iii randomized trial (krog 1701)

Haeyoung Kim, Heejung Kim, Won Park, Jong Yun Baek, Sung Ja Ahn, Mi Young Kim, Shin Hyung Park, Ik Jae Lee, Inbong Ha, Jin Hee Kim, Tae Hyun Kim, Kyu Chan Lee, Hyung Sik Lee, Tae Gyu Kim, Jin Ho Kim, Jong Hoon Lee, Jinhong Jung, Oyeon Cho, Jee Suk Chang, Eun Seog KimIn Young Jo, Taeryool Koo, Kyubo Kim, Hae Jin Park, Young Joo Shin, Boram Ha, Jeanny Kwon, Ju Hye Lee, Sunrock Moon

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Article number3261
Pages (from-to)1-10
Number of pages10
JournalCancers
Volume12
Issue number11
DOIs
StatePublished - Nov 2020

Keywords

  • Breast cancer
  • Lymph nodes
  • Radiotherapy planning
  • Randomized trial

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