Editor-in-Chief Emeritus Pick of Papers
Free access for our readers
For each issue of Radiotherapy and Oncology, the Editor-in-Chief Emeritus Jens Overgaard, picks his favourite papers.
- The internal mammary nodes (IMN) receive lymphatic drainage from all quadrants of the breast [1–5], with predominant drainage to IMNs in case of inner quadrant and deeply located nonpalpable tumours . Among patients who have pathologically node-negative axillary disease, up to 10% may have IMN tumour involvement, which increases to almost 40% in case of involved positive axillary nodes [1–6]. IMN dissection was not shown to provide survival benefit . For many years thereafter, elective IMN irradiation was controversial, as data were conflicting for disease outcome benefits vs potential detrimental effects of radiation therapy (RT) [7,8].
- Up to the late nineties, most departments used Cobalt-60 (Co-60) Units for radiation therapy (RT) for superficially located indications, including postmastectomy RT (PMRT) for early breast cancer. With the transition to linear accelerator photon-based RT, bolus material was often added to allow for a similar surface dose distribution as received with the Co-60 machines due to the skin sparing effect of photons . Bolus serves as a tissue equivalent material that shifts the 95–100% isodose towards the skin and subcutaneous tissue (depending on the thickness of bolus and subcutaneous tissue) .
- Breast-conserving surgery (BCS) and adjuvant whole breast irradiation (WBI) has become the standard-therapy for early-stage breast cancer with equivalent overall survival and local control rates compared to mastectomy [1–3]. For further improvement of local control in younger patients or patients with high-risk tumors, an additional boost irradiation to the former tumor bed is recommended, which is usually delivered sequentially . However, with techniques like intensity-modulated radiotherapy (IMRT) a simultaneously integrated boost (SIB) may be applied.
- Delineation of target and ‘organ at risk’ volumes is a critical part of modern radiation therapy planning, the next essential step after deciding the indication, patient discussion and image acquisition. Adoption of volume-based treatment planning for non-metastatic breast cancer has increased greatly along with the use of improved planning techniques, essential for modern therapy. However, identifying the volumes on a planning CT is no easy task. The current paper is written by ESTRO’s breast course faculty, providing tricks and tips for target volume definition and delineation for optimal postoperative breast cancer irradiation.
- Our aim was to assess the effect of adjuvant radiotherapy on recurrence and survival for elderly women (≥70) with early-stage hormone receptor-positive breast cancer treated with breast conserving surgery (BCS) and Tamoxifen.
- To describe long-term failure pattern after early-stage breast cancer in relation to local treatment (breast-conserving therapy (BCT) or mastectomy) and age.
- Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists.
- To compare mean heart and left anterior descending coronary artery (LAD) doses (NTDmean) and positional reproducibility in larger-breasted women receiving left breast radiotherapy using supine voluntary deep-inspiratory breath-hold (VBH) and free-breathing prone techniques.