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Multicenter Study
. 2023 Dec;109(6):570-575.
doi: 10.1177/03008916231196801. Epub 2023 Sep 9.

Impact of inter-observer variability on first axillary level dosimetry in breast cancer radiotherapy: An AIRO multi-institutional study

Maria Cristina Leonardi  1 , Matteo Pepa  1 , Mattia Zaffaroni  1 , Maria Giulia Vincini, Rosa Luraschi  2 , Sabrina Vigorito  2 , Anna Morra  1 , Samantha Dicuonzo  1 , Giovanni Carlo Mazzola  1 , Marianna Alessandra Gerardi  1 , Maria Alessia Zerella  1 , Domenico Cante  3 , Edoardo Petrucci  4 , Giuseppina Borzì  5 , Maristella Marrocco  6 , Matteo Chieregato  7 , Luciano Iadanza  8 , Francesca Lobefalo  9 , Marco Valenti  10 , Anna Cavallo  11 , Serenella Russo  12 , Marika Guernieri  13 , Tiziana Malatesta  14 , Ilaria Meaglia  15 , Marco Liotta  16 , Isabella Palumbo  17 , Marta Marcantonini  18 , Emilio Mezzenga  19 , Sara Falivene  20 , Cecilia Arrichiello  21 , Maria Paola Barbero  22 , Giovanni Battista Ivaldi  15 , Gianpiero Catalano  23 , Cristiana Vidali  24 , Caterina Giannitto  25 , Antonella Ciabattoni  26 , Icro Meattini  27   28 , Cynthia Aristei  17 , Roberto Orecchia  29 , Federica Cattani  2 , Barbara Alicja Jereczek-Fossa  1   30
Affiliations
Multicenter Study

Impact of inter-observer variability on first axillary level dosimetry in breast cancer radiotherapy: An AIRO multi-institutional study

Maria Cristina Leonardi et al. Tumori. 2023 Dec.

Abstract

This study quantified the incidental dose to the first axillary level (L1) in locoregional treatment plan for breast cancer. Eighteen radiotherapy centres contoured L1-L4 on three different patients (P1,2,3), created the L2-L4 planning target volume (single centre planning target volume, SC-PTV) and elaborated a locoregional treatment plan. The L2-L4 gold standard clinical target volume (CTV) along with the gold standard L1 contour (GS-L1) were created by an expert consensus. The SC-PTV was then replaced by the GS-PTV and the incidental dose to GS-L1 was measured. Dosimetric data were analysed with Kruskal-Wallis test. Plans were intensity modulated radiotherapy (IMRT)-based. P3 with 90° arm setup had statistically significant higher L1 dose across the board than P1 and P2, with the mean dose (Dmean) reaching clinical significance. Dmean of P1 and P2 was consistent with the literature (77.4% and 74.7%, respectively). The incidental dose depended mostly on L1 proportion included in the breast fields, underlining the importance of the setup, even in case of IMRT.

Keywords: breast cancer; contouring; first axillary level; inter-observer variability.

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Conflict of interest statement

Declaration of Conflicting InterestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Division of Radiotherapy IEO received research funding from AIRC (Italian Association for Cancer Research) and Fondazione IEO-CCM (Istituto Europeo di Oncologia-Centro Cardiologico Monzino) (all outside the current project). BAJF received speakers fee from Roche, Bayer, Janssen, Carl Zeiss, Ipsen, Accuray, Astellas, Elekta, IBA Astra Zeneca (all outside the current project). MCL received a speaker fee from Accuray Inc (outside the current project). SD received speakers fee from Accuray Asia (outside the current project). MGV was supported by a research fellowship from AIRC entitled “Radioablation ± hormonotherapy for prostate cancer oligorecurrences (RADIOSA trial): potential of imaging and biology”, registered at ClinicalTrials.gov NCT03940235, approved by the Ethics Committee of IRCCS Istituto Europeo di Oncologia and Centro Cardiologico Monzino (IEO-997). IEO, the European Institute of Oncology IRCCS, was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5x1000 funds and by institutional grants from Accuray Inc. The sponsors did not play any role in the study design, collection, analysis and interpretation of data, nor in the writing of the manuscript, nor in the decision to submit the manuscript for publication. The remaining authors declare no conflict of interest that are relevant to the content of this article.

Figures

Figure 1.
Figure 1.
First axillary level (L1) percentage dose in terms of near-min dose (D95, a), near-max dose (D2, b), V95% (c), and mean dose (Dmean, d) for the three case patients. List of abbreviations. D2 = Dose delivered to 2% of volume (Dnear-max); D95 = Dose delivered to 98% of volume (Dnear-min); P = Patient; SD = Standard Deviation.
See this image and copyright information in PMC

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