Patterns of practice of regional nodal irradiation in breast cancer: results of the European Organization for Research and Treatment of Cancer (EORTC) NOdal Radiotherapy (NORA) survey.

Détails

Ressource 1Télécharger: serval:BIB_38D91B4228D2.P001 (114.35 [Ko])
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ID Serval
serval:BIB_38D91B4228D2
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Patterns of practice of regional nodal irradiation in breast cancer: results of the European Organization for Research and Treatment of Cancer (EORTC) NOdal Radiotherapy (NORA) survey.
Périodique
Annals of Oncology
Auteur(s)
Belkacemi Y., Kaidar-Person O., Poortmans P., Ozsahin M., Valli M.C., Russell N., Kunkler I., Hermans J., Kuten A., van Tienhoven G., Westenberg H.
Collaborateur(s)
Breast Working Party of the EORTC Radiation Oncology Group (ROG)
ISSN
1569-8041 (Electronic)
ISSN-L
0923-7534
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
26
Numéro
3
Pages
529-535
Langue
anglais
Résumé
BACKGROUND: Predicting outcome of breast cancer (BC) patients based on sentinel lymph node (SLN) status without axillary lymph node dissection (ALND) is an area of uncertainty. It influences the decision-making for regional nodal irradiation (RNI). The aim of the NORA (NOdal RAdiotherapy) survey was to examine the patterns of RNI.
METHODS: A web-questionnaire, including several clinical scenarios, was distributed to 88 EORTC-affiliated centers. Responses were received between July 2013 and January 2014.
RESULTS: A total of 84 responses were analyzed. While three-dimensional (3D) radiotherapy (RT) planning is carried out in 81 (96%) centers, nodal areas are delineated in only 51 (61%) centers. Only 14 (17%) centers routinely link internal mammary chain (IMC) and supraclavicular node (SCN) RT indications. In patients undergoing total mastectomy (TM) with ALND, SCN-RT is recommend by 5 (6%), 53 (63%) and 51 (61%) centers for patients with pN0(i+), pN(mi) and pN1, respectively. Extra-capsular extension (ECE) is the main factor influencing decision-making RNI after breast conserving surgery (BCS) and TM. After primary systemic therapy (PST), 49 (58%) centers take into account nodal fibrotic changes in ypN0 patients for RNI indications. In ypN0 patients with inner/central tumors, 23 (27%) centers indicate SCN-RT and IMC-RT. In ypN1 patients, SCN-RT is delivered by less than half of the centers in patients with ypN(i+) and ypN(mi). Twenty-one (25%) of the centers recommend ALN-RT in patients with ypN(mi) or 1-2N+ after ALND. Seventy-five (90%) centers state that age is not considered a limiting factor for RNI.
CONCLUSION: The NORA survey is unique in evaluating the impact of SLNB/ALND status on adjuvant RNI decision-making and volumes after BCS/TM with or without PST. ALN-RT is often indicated in pN1 patients, particularly in the case of ECE. Besides the ongoing NSABP-B51/RTOG and ALLIANCE trials, NORA could help to design future specific RNI trials in the SLNB era without ALND in patients receiving or not PST.
Mots-clé
Breast Neoplasms/diagnosis, Breast Neoplasms/epidemiology, Europe/epidemiology, Female, Humans, Lymphatic Irradiation/methods, Lymphatic Irradiation/standards, Practice Guidelines as Topic/standards, Surveys and Questionnaires, Treatment Outcome
Pubmed
Web of science
Open Access
Oui
Création de la notice
01/05/2015 17:12
Dernière modification de la notice
25/09/2019 6:08
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