Partial breast irradiation after sentinel lymph node biopsy omission: Is it a valid alternative to whole breast Irradiation? Analysis of the dose to the sentinel lymph node region during whole breast irradiation vs. partial breast irradiation
Background: Sentinel lymph node biopsy (SLNB) can be safely omitted in selected early-stage, clinically node-negative breast cancer (BC) patients. While these patients are also candidates for partial breast irradiation (PBI), the dosimetric effects of PBI on the sentinel lymph node region (SLNs) and...
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Elsevier
2025-08-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0960977625005405 |
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| author | Sophie T. Behzadi Rebecca Moser Mathias Düsberg Maximilian Aigner Jana Nano Sophia Kiesl Jacqueline Lammert Evelyn Klein Georg P. Schmidt Marion Kiechle Thomas Huber Stefanie Corradini Stephanie E. Combs Kai J. Borm |
| author_facet | Sophie T. Behzadi Rebecca Moser Mathias Düsberg Maximilian Aigner Jana Nano Sophia Kiesl Jacqueline Lammert Evelyn Klein Georg P. Schmidt Marion Kiechle Thomas Huber Stefanie Corradini Stephanie E. Combs Kai J. Borm |
| author_sort | Sophie T. Behzadi |
| collection | DOAJ |
| description | Background: Sentinel lymph node biopsy (SLNB) can be safely omitted in selected early-stage, clinically node-negative breast cancer (BC) patients. While these patients are also candidates for partial breast irradiation (PBI), the dosimetric effects of PBI on the sentinel lymph node region (SLNs) and axillary levels remain unclear. Methods: In this study, SLNs were identified and contoured in 100 BC patients using pre- and postoperative imaging. Axillary levels were contoured following ESTRO guidelines. Dose distribution to the SLN (n = 9000 data points) and axillary levels (n = 270 data points) were analyzed for whole breast irradiation (WBI) and PBI across different techniques (3D-conformal radiation therapy [3D-CRT] vs. volumetric modulated arc therapy [VMAT]), deep inspiration breath-hold [DIBH] vs. free breathing [FB]), and anatomical variations (breast size, tumor site, and upper breast border). Results: WBI provided full therapeutic dose coverage (>95 % of the prescribed dose) to 65 % of SLNs, compared to only 10 % (3D-CRT) and 3 % (VMAT) with PBI. DIBH significantly reduced dose distribution to SLN and axillary levels compared to FB. Lower incidental dose coverage was also observed in patients with medial/central tumors, smaller breasts, and lower upper breast borders. Conclusion: These results demonstrate that PBI delivers substantially lower incidental dose to the SLN than WBI. Since patients in the INSEMA and SOUND trials were predominantly treated with WBI, combining SLNB omission with PBI should not be considered a standard approach and warrants further investigation. |
| format | Article |
| id | doaj-art-4e8cd493bd9f47869816d79d1f3762b8 |
| institution | DOAJ |
| issn | 1532-3080 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Breast |
| spelling | doaj-art-4e8cd493bd9f47869816d79d1f3762b82025-08-20T02:40:48ZengElsevierBreast1532-30802025-08-018210452310.1016/j.breast.2025.104523Partial breast irradiation after sentinel lymph node biopsy omission: Is it a valid alternative to whole breast Irradiation? Analysis of the dose to the sentinel lymph node region during whole breast irradiation vs. partial breast irradiationSophie T. Behzadi0Rebecca Moser1Mathias Düsberg2Maximilian Aigner3Jana Nano4Sophia Kiesl5Jacqueline Lammert6Evelyn Klein7Georg P. Schmidt8Marion Kiechle9Thomas Huber10Stefanie Corradini11Stephanie E. Combs12Kai J. Borm13Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Radiation Oncology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Radiation Oncology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Radiation Oncology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Radiation Oncology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Radiation Oncology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Gynecology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Gynecology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Gynecology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Gynecology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Radiology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Radiation Oncology, University Hospital, LMU Munich, Munich, GermanyDepartment of Radiation Oncology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany; German Consortium for Translational Cancer Research (dktk), Partner Site Munich, GermanyDepartment of Radiation Oncology, TUM School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Corresponding author. Department of Radiation Oncology, TUM School of Medicine and Health, Ismaninger Straße 22, 81675, Munich, Germany.Background: Sentinel lymph node biopsy (SLNB) can be safely omitted in selected early-stage, clinically node-negative breast cancer (BC) patients. While these patients are also candidates for partial breast irradiation (PBI), the dosimetric effects of PBI on the sentinel lymph node region (SLNs) and axillary levels remain unclear. Methods: In this study, SLNs were identified and contoured in 100 BC patients using pre- and postoperative imaging. Axillary levels were contoured following ESTRO guidelines. Dose distribution to the SLN (n = 9000 data points) and axillary levels (n = 270 data points) were analyzed for whole breast irradiation (WBI) and PBI across different techniques (3D-conformal radiation therapy [3D-CRT] vs. volumetric modulated arc therapy [VMAT]), deep inspiration breath-hold [DIBH] vs. free breathing [FB]), and anatomical variations (breast size, tumor site, and upper breast border). Results: WBI provided full therapeutic dose coverage (>95 % of the prescribed dose) to 65 % of SLNs, compared to only 10 % (3D-CRT) and 3 % (VMAT) with PBI. DIBH significantly reduced dose distribution to SLN and axillary levels compared to FB. Lower incidental dose coverage was also observed in patients with medial/central tumors, smaller breasts, and lower upper breast borders. Conclusion: These results demonstrate that PBI delivers substantially lower incidental dose to the SLN than WBI. Since patients in the INSEMA and SOUND trials were predominantly treated with WBI, combining SLNB omission with PBI should not be considered a standard approach and warrants further investigation.http://www.sciencedirect.com/science/article/pii/S0960977625005405Sentinel lymph node biopsy omissionLow-risk breast cancerIncidental nodal irradiationWhole breast irradiationPartial breast irradiation |
| spellingShingle | Sophie T. Behzadi Rebecca Moser Mathias Düsberg Maximilian Aigner Jana Nano Sophia Kiesl Jacqueline Lammert Evelyn Klein Georg P. Schmidt Marion Kiechle Thomas Huber Stefanie Corradini Stephanie E. Combs Kai J. Borm Partial breast irradiation after sentinel lymph node biopsy omission: Is it a valid alternative to whole breast Irradiation? Analysis of the dose to the sentinel lymph node region during whole breast irradiation vs. partial breast irradiation Breast Sentinel lymph node biopsy omission Low-risk breast cancer Incidental nodal irradiation Whole breast irradiation Partial breast irradiation |
| title | Partial breast irradiation after sentinel lymph node biopsy omission: Is it a valid alternative to whole breast Irradiation? Analysis of the dose to the sentinel lymph node region during whole breast irradiation vs. partial breast irradiation |
| title_full | Partial breast irradiation after sentinel lymph node biopsy omission: Is it a valid alternative to whole breast Irradiation? Analysis of the dose to the sentinel lymph node region during whole breast irradiation vs. partial breast irradiation |
| title_fullStr | Partial breast irradiation after sentinel lymph node biopsy omission: Is it a valid alternative to whole breast Irradiation? Analysis of the dose to the sentinel lymph node region during whole breast irradiation vs. partial breast irradiation |
| title_full_unstemmed | Partial breast irradiation after sentinel lymph node biopsy omission: Is it a valid alternative to whole breast Irradiation? Analysis of the dose to the sentinel lymph node region during whole breast irradiation vs. partial breast irradiation |
| title_short | Partial breast irradiation after sentinel lymph node biopsy omission: Is it a valid alternative to whole breast Irradiation? Analysis of the dose to the sentinel lymph node region during whole breast irradiation vs. partial breast irradiation |
| title_sort | partial breast irradiation after sentinel lymph node biopsy omission is it a valid alternative to whole breast irradiation analysis of the dose to the sentinel lymph node region during whole breast irradiation vs partial breast irradiation |
| topic | Sentinel lymph node biopsy omission Low-risk breast cancer Incidental nodal irradiation Whole breast irradiation Partial breast irradiation |
| url | http://www.sciencedirect.com/science/article/pii/S0960977625005405 |
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