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†

Predicting breast cancer outcome based on SLN node status without ALND is currently an area of uncertainty in SLN+ patients. These uncertainties influence the decision-making of adjuvant nodal irradiation. The NORA Survey was designed to examine the patterns of RNI practice in Europe to provide a basis for designing future trials in areas of equipoise in clinical decision-making concerning RN

The Persistent Problem of Local/Regional Failure After Surgical Intervention for Early-Stage Lung Cancer

Background: The goal of the present study was to estimate the rate of local/regional failure (LRF) after definitive surgical intervention for early-stage non-small cell lung cancer (NSCLC), without postoperative radiotherapy, in the era of contemporary imaging and minimally invasive surgical techniques. Methods: Medical records of patients with early-stage NSCLC (pathologic T1-4, N0-1) who underwent lobectomy, sleeve lobectomy, bilobectomy, or pneumonectomy, with or without adjuvant chemotherapy, between 2007 and 2015, were retrospectively reviewed. LRF was defined as recurrence at the ipsilateral lung, bronchial stump, mediastinum, chest wall, or supraclavicular region. The Kaplan-Meier method was used to estimate time to LRF, with patients censored at death, and log-rank tests were used for comparisons. A two-sided p value of less than 0.05 was considered significant. Results: Included were 217 patients (median age, 65 years). Preoperative staging with positron emission tomography/computed tomography was performed in 89% of patients, mediastinoscopy was performed in 42%, and video-assisted thoracoscopic surgery was performed in 51%. At a median follow-up of 36 months (range, 1 to 120 months), the 5-year estimated LRF was 26% (95% confidence interval, 20% to 35%). LRF rates were not significantly different in those with and without staging positron emission tomography/computed tomography (hazard ratio, 1.52; p = 0.43) and those with video-assisted thoracoscopic surgery versus open thoracotomy (hazard ratio, 1.00; p = 0.99). Conclusions: Despite contemporary staging procedures and surgical techniques for early-stage NSCLC, LRF occurs in approximately 1 of 4 patients. The observed rates of LRF are similar to those reported more than a decade ago, suggesting that local/regional control remains a persistent problem. The use of additional local treatments, such as radiotherapy, should be reevaluated to further improve outcomes

ESTRO consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant-based immediate reconstruction for early stage breast cancer

© 2019 Elsevier B.V. Immediate breast reconstruction (IBR) rates after mastectomy are increasing. Postmastectomy radiation therapy (PMRT) contouring guidelines for target volumes in the setting of IBR are lacking. Therefore, many patients who have had IBR receive PMRT to target volumes similar to conventional simulator-based whole breast irradiation. The aim of this paper is to describe delineation guidelines for PMRT after implant-based IBR based on a thorough understanding of the surgical procedures, disease stage, patterns of recurrence and radiation techniques. They are based on a consensus endorsed by a global multidisciplinary group of breast cancer experts

Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy

Aim Demand for nipple- and skin- sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recommendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BR

Re-irradiation and Hyperthermia in Breast Cancer

Half of locoregional recurrences after breast cancer treatment are isolated events. Restaging should be carried out to select patients for curative salvage treatment. The approach depends on the characteristics of the primary and recurrent cancer, previous locoregional and systemic treatments, site of recurrence, comorbidities and the patient's wishes. A multidisciplinary discussion should be associated with the shared decision-making process. In view of the potential long-term disease-free survival, meticulous target volume delineation and selection of the most appropriate techniques should be used to decrease the risk of toxicity. This overview aims to provide clinicians with tools to manage the different scenarios of breast cancer patients with locoregional recurrences in the context of re-irradiation. (C) 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserve