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Regional recurrence after adjuvant breast cancer radiotherapy is not due to insufficient target coverage

Published:January 14, 2015DOI:https://doi.org/10.1016/j.radonc.2014.12.012
      With modern multimodal breast cancer treatment the incidence of regional recurrences (RR) has declined considerably over the last decades, and the risk of RR is now so low that surgeons investigate how to safely manage node positive breast cancer patients with less surgery [
      • Giuliano A.E.
      • McCall L.
      • Beitsch P.
      Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial.
      ,
      • Donker M.
      • van Tienhoven G.
      • Straver M.E.
      • et al.
      Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial.
      ]. In high risk patients treated with standard axillary lymph node dissection (ALND) and radiotherapy (RT) of regional nodes the RR risk is <1% in the first decade after surgery [
      • Thorsen L.B.J.
      • Berg M.
      • Brodersen H.J.
      • et al.
      Improved survival with internal mammary node irradiation: a prospective study on 3072 breast cancer patients.
      ].
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      References

        • Giuliano A.E.
        • McCall L.
        • Beitsch P.
        Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial.
        Ann Surg. 2010; 252 (discussion 432–3): 426-432
        • Donker M.
        • van Tienhoven G.
        • Straver M.E.
        • et al.
        Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial.
        Lancet Oncol. 2014; 15: 1303-1310
        • Thorsen L.B.J.
        • Berg M.
        • Brodersen H.J.
        • et al.
        Improved survival with internal mammary node irradiation: a prospective study on 3072 breast cancer patients.
        Radiother Oncol. 2014; 111 ([Abstract OC-0148]): 68
        • Overgaard M.
        • Hansen P.S.
        • Overgaard J.
        • et al.
        Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group DBCG 82b Trial.
        N Engl Med. 1997; 337: 949-955
        • Overgaard M.
        • Jensen M.B.
        • Overgaard J.
        • et al.
        Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen. Danish Breast Cancer Cooperative Group DBCG 82c randomised trial.
        Lancet. 1999; 353: 1641-1648
        • Ragaz J.
        • Jackson S.M.
        • Le N.
        • et al.
        Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer.
        N Engl J Med. 1997; 337: 956-962
        • Dijkema I.M.
        • Hofman P.
        • Cornelis P.J.
        • et al.
        Loco-regional conformal radiotherapy of the breast: delineation of the regional lymph node clinical target volumes in treatment position.
        Radiother Oncol. 2004; 71: 287-295
        • Kirova Y.M.
        • Castro Pena P.
        • Dendale R.
        • et al.
        Simplified rules for everyday delineation of lymph node areas for breast cancer radiotherapy.
        Br J Radiol. 2010; 83: 683-686
        • Nielsen M.H.
        • Berg M.
        • Pedersen A.N.
        • et al.
        Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: national guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group.
        Acta Oncol. 2013; 52: 703-710
        • Offersen B.V.
        • Boersma L.J.
        • Kirkove C.
        • et al.
        ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer.
        Radiother Oncol. 2015; 114: 3-10
        • Poortmans P.
        • Kirkove C.
        • Budach V.
        • et al.
        Irradiation of the internal mammary and medial supraclavicular lymph nodes in stage I to III breast cancer: 10 years results of the EORTC radiation oncology and breast cancer groups phase III trial 22922/10925.
        Eur J Can. 2013; 47 ([Abstract])
        • Whelan T.
        • Ackerman I.
        • Chapman J.W.
        • et al.
        NCIC-CTG MA.20: an intergroup trial of regional nodal irradiation in early breast cancer.
        J Clin Oncol. 2011; 29 ([Abstract])
        • Grantzau T.
        • Mellemkjær L.
        • Overgaard J.
        Second primary cancers after adjuvant radiotherapy in early breast cancer patients: a national population based study under the Danish Breast Cancer Cooperative Group (DBCG).
        Radiother Oncol. 2013; 106: 42-49
        • Darby S.C.
        • Ewertz M.
        • McGale P.
        • et al.
        Risk of ischemic heart disease in women after radiotherapy for breast cancer.
        N Engl J Med. 2013; 368: 987-998