Quality assurance of internal mammary node irradiation in the DBCG IMN2 study

Lasse Refsgaard; Emma S. Buhl; Anders W. Mølby Nielsen; Mette S. Thomsen; Karen Andersen; Ingelise Jensen; Martin Berg; Ebbe L. Lorenzen; Lise B. J. Thorsen; Jens Overgaard; Stine S. Korreman; Birgitte V. Offersen; DBCG RT Committee

doi:10.1016/j.radonc.2024.110600

Quality assurance of internal mammary node irradiation in the DBCG IMN2 study

Lasse Refsgaard, Emma S. Buhl, Anders W. Mølby Nielsen^*, Mette S. Thomsen, Karen Andersen, Ingelise Jensen, Martin Berg, Ebbe L. Lorenzen, Lise B. J. Thorsen, Jens Overgaard, Stine S. Korreman, Birgitte V. Offersen, DBCG RT Committee

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Abstract

PURPOSE/OBJECTIVE: The Danish Breast Cancer Group (DBCG) IMN2 study investigated the gain from internal mammary node irradiation (IMNI) in node-positive breast cancer patients. IMNI was indicated in right-sided patients, but not in left-sided. Target volume delineations were based on bony landmarks in contrast to the contemporary vessel-based ESTRO consensus guideline. Our objective was to compare IMNI doses in right-sided versus left-sided patients.

MATERIAL/METHODS: Treatment plans and delineated structures including CTVn_IMN (IMN_old) from 2008 to 2014 were collected from the DBCG RT Nation study. During the study period, IMN_old was only delineated in right-sided patients. Right and left-sided CTVn_IMN structures were auto-segmented following the ESTRO guidelines (IMN_ESTRO). Due to cranial discordance between IMN_old and IMN_ESTRO, the IMN_ESTRO models were separated into IMN_ESTRO_cranial and IMN_ESTRO_intercostal space(IC)1-3, IC1-4, and IC4_only.

RESULTS: Treatment plans for 2837 patients were available (62.5 % of patients in the IMN2 study). In right-sided patients, the median IMN_old dose coverage (92.4 %) was higher than IMN_ESTRO (71.7 %), p < 0.001. Dose coverage in IMN_ESTRO_IC1-3 was comparable to IMN_old. Comparing IMN_ESTRO_IC1-3 in all patients by laterality, the median CTVn_V90% was 94.6 % (IQR 64.8-100.0) in right-sided patients and 20.4 % (IQR 0.9-55.8) in left-sided patients, p < 0.001. For right-sided patients, median CTV_V90% was 82.3 % in IMN_ESTRO_IC4_only. Median mean heart doses were lower in right-sided patients (1.2 Gy) than in left-sided (2.3 Gy), p < 0.001. Median mean lung doses were higher in right-sided patients (16.0 Gy) than in left-sided (12.7 Gy), p < 0.001.

CONCLUSION: For IMN_ESTRO_IC1-3, we found a significantly higher IMN dose coverage in right-sided than in left-sided patients supporting treatment according to study guidelines in the DBCG IMN2 study.

Originalsprog	Engelsk
Artikelnummer	110600
Tidsskrift	Radiotherapy and Oncology
Vol/bind	202
Antal sider	8
ISSN	0167-8140
DOI	https://doi.org/10.1016/j.radonc.2024.110600
Status	Udgivet - jan. 2025

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10.1016/j.radonc.2024.110600Licens: CC BY 4.0

Refsgaard et al. (2025). Quality assurance of internal mammary node irradiation in the DBCG IMN2 studyForlagets udgivne version, 940 KBLicens: CC BY 4.0

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Refsgaard, L., Buhl, E. S., Nielsen, A. W. M., Thomsen, M. S., Andersen, K., Jensen, I., Berg, M., Lorenzen, E. L., Thorsen, L. B. J., Overgaard, J., Korreman, S. S., Offersen, B. V., & DBCG RT Committee (2025). Quality assurance of internal mammary node irradiation in the DBCG IMN2 study. Radiotherapy and Oncology, 202, Artikel 110600. https://doi.org/10.1016/j.radonc.2024.110600

@article{c6bf9dd00e4641e89f518c1c4e1cc885,

title = "Quality assurance of internal mammary node irradiation in the DBCG IMN2 study",

abstract = "PURPOSE/OBJECTIVE: The Danish Breast Cancer Group (DBCG) IMN2 study investigated the gain from internal mammary node irradiation (IMNI) in node-positive breast cancer patients. IMNI was indicated in right-sided patients, but not in left-sided. Target volume delineations were based on bony landmarks in contrast to the contemporary vessel-based ESTRO consensus guideline. Our objective was to compare IMNI doses in right-sided versus left-sided patients.MATERIAL/METHODS: Treatment plans and delineated structures including CTVn_IMN (IMN_old) from 2008 to 2014 were collected from the DBCG RT Nation study. During the study period, IMN_old was only delineated in right-sided patients. Right and left-sided CTVn_IMN structures were auto-segmented following the ESTRO guidelines (IMN_ESTRO). Due to cranial discordance between IMN_old and IMN_ESTRO, the IMN_ESTRO models were separated into IMN_ESTRO_cranial and IMN_ESTRO_intercostal space(IC)1-3, IC1-4, and IC4_only.RESULTS: Treatment plans for 2837 patients were available (62.5 % of patients in the IMN2 study). In right-sided patients, the median IMN_old dose coverage (92.4 %) was higher than IMN_ESTRO (71.7 %), p < 0.001. Dose coverage in IMN_ESTRO_IC1-3 was comparable to IMN_old. Comparing IMN_ESTRO_IC1-3 in all patients by laterality, the median CTVn_V90% was 94.6 % (IQR 64.8-100.0) in right-sided patients and 20.4 % (IQR 0.9-55.8) in left-sided patients, p < 0.001. For right-sided patients, median CTV_V90% was 82.3 % in IMN_ESTRO_IC4_only. Median mean heart doses were lower in right-sided patients (1.2 Gy) than in left-sided (2.3 Gy), p < 0.001. Median mean lung doses were higher in right-sided patients (16.0 Gy) than in left-sided (12.7 Gy), p < 0.001.CONCLUSION: For IMN_ESTRO_IC1-3, we found a significantly higher IMN dose coverage in right-sided than in left-sided patients supporting treatment according to study guidelines in the DBCG IMN2 study.",

keywords = "Auto-segmentation, Internal mammary node irradiation, Quality assurance, The DBCG IMN2 study",

author = "Lasse Refsgaard and Buhl, {Emma S.} and Nielsen, {Anders W. M{\o}lby} and Thomsen, {Mette S.} and Karen Andersen and Ingelise Jensen and Martin Berg and Lorenzen, {Ebbe L.} and Thorsen, {Lise B. J.} and Jens Overgaard and Korreman, {Stine S.} and Offersen, {Birgitte V.} and {DBCG RT Committee}",

year = "2025",

month = jan,

doi = "10.1016/j.radonc.2024.110600",

language = "English",

volume = "202",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier",

}

TY - JOUR

T1 - Quality assurance of internal mammary node irradiation in the DBCG IMN2 study

AU - Refsgaard, Lasse

AU - Buhl, Emma S.

AU - Nielsen, Anders W. Mølby

AU - Thomsen, Mette S.

AU - Andersen, Karen

AU - Jensen, Ingelise

AU - Berg, Martin

AU - Lorenzen, Ebbe L.

AU - Thorsen, Lise B. J.

AU - Overgaard, Jens

AU - Korreman, Stine S.

AU - Offersen, Birgitte V.

AU - DBCG RT Committee

PY - 2025/1

Y1 - 2025/1

N2 - PURPOSE/OBJECTIVE: The Danish Breast Cancer Group (DBCG) IMN2 study investigated the gain from internal mammary node irradiation (IMNI) in node-positive breast cancer patients. IMNI was indicated in right-sided patients, but not in left-sided. Target volume delineations were based on bony landmarks in contrast to the contemporary vessel-based ESTRO consensus guideline. Our objective was to compare IMNI doses in right-sided versus left-sided patients.MATERIAL/METHODS: Treatment plans and delineated structures including CTVn_IMN (IMN_old) from 2008 to 2014 were collected from the DBCG RT Nation study. During the study period, IMN_old was only delineated in right-sided patients. Right and left-sided CTVn_IMN structures were auto-segmented following the ESTRO guidelines (IMN_ESTRO). Due to cranial discordance between IMN_old and IMN_ESTRO, the IMN_ESTRO models were separated into IMN_ESTRO_cranial and IMN_ESTRO_intercostal space(IC)1-3, IC1-4, and IC4_only.RESULTS: Treatment plans for 2837 patients were available (62.5 % of patients in the IMN2 study). In right-sided patients, the median IMN_old dose coverage (92.4 %) was higher than IMN_ESTRO (71.7 %), p < 0.001. Dose coverage in IMN_ESTRO_IC1-3 was comparable to IMN_old. Comparing IMN_ESTRO_IC1-3 in all patients by laterality, the median CTVn_V90% was 94.6 % (IQR 64.8-100.0) in right-sided patients and 20.4 % (IQR 0.9-55.8) in left-sided patients, p < 0.001. For right-sided patients, median CTV_V90% was 82.3 % in IMN_ESTRO_IC4_only. Median mean heart doses were lower in right-sided patients (1.2 Gy) than in left-sided (2.3 Gy), p < 0.001. Median mean lung doses were higher in right-sided patients (16.0 Gy) than in left-sided (12.7 Gy), p < 0.001.CONCLUSION: For IMN_ESTRO_IC1-3, we found a significantly higher IMN dose coverage in right-sided than in left-sided patients supporting treatment according to study guidelines in the DBCG IMN2 study.

AB - PURPOSE/OBJECTIVE: The Danish Breast Cancer Group (DBCG) IMN2 study investigated the gain from internal mammary node irradiation (IMNI) in node-positive breast cancer patients. IMNI was indicated in right-sided patients, but not in left-sided. Target volume delineations were based on bony landmarks in contrast to the contemporary vessel-based ESTRO consensus guideline. Our objective was to compare IMNI doses in right-sided versus left-sided patients.MATERIAL/METHODS: Treatment plans and delineated structures including CTVn_IMN (IMN_old) from 2008 to 2014 were collected from the DBCG RT Nation study. During the study period, IMN_old was only delineated in right-sided patients. Right and left-sided CTVn_IMN structures were auto-segmented following the ESTRO guidelines (IMN_ESTRO). Due to cranial discordance between IMN_old and IMN_ESTRO, the IMN_ESTRO models were separated into IMN_ESTRO_cranial and IMN_ESTRO_intercostal space(IC)1-3, IC1-4, and IC4_only.RESULTS: Treatment plans for 2837 patients were available (62.5 % of patients in the IMN2 study). In right-sided patients, the median IMN_old dose coverage (92.4 %) was higher than IMN_ESTRO (71.7 %), p < 0.001. Dose coverage in IMN_ESTRO_IC1-3 was comparable to IMN_old. Comparing IMN_ESTRO_IC1-3 in all patients by laterality, the median CTVn_V90% was 94.6 % (IQR 64.8-100.0) in right-sided patients and 20.4 % (IQR 0.9-55.8) in left-sided patients, p < 0.001. For right-sided patients, median CTV_V90% was 82.3 % in IMN_ESTRO_IC4_only. Median mean heart doses were lower in right-sided patients (1.2 Gy) than in left-sided (2.3 Gy), p < 0.001. Median mean lung doses were higher in right-sided patients (16.0 Gy) than in left-sided (12.7 Gy), p < 0.001.CONCLUSION: For IMN_ESTRO_IC1-3, we found a significantly higher IMN dose coverage in right-sided than in left-sided patients supporting treatment according to study guidelines in the DBCG IMN2 study.

KW - Auto-segmentation

KW - Internal mammary node irradiation

KW - Quality assurance

KW - The DBCG IMN2 study

UR - http://www.scopus.com/inward/record.url?scp=85209086493&partnerID=8YFLogxK

U2 - 10.1016/j.radonc.2024.110600

DO - 10.1016/j.radonc.2024.110600

M3 - Journal article

C2 - 39521277

SN - 0167-8140

VL - 202

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

M1 - 110600

ER -

Quality assurance of internal mammary node irradiation in the DBCG IMN2 study

Abstract

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