Individual departments worked to develop guidelines however these remained confined to department use and often varied greatly between departments and even colleagues treating similar patients in the same department. Institutions had varied approaches to contouring and were asymmetric in the process of both acquiring and applying tools for daily work, therefore there was non-uniformity in the adoption of contouring tools and volumetric metrics in the radiation oncology community which led to asymmetry in the application of volumetric planning. Radiation oncologists had to learn how to contour and draw the breast, surgical cavity, and draining lymph nodes on CT with tools designed for a new generation. Although most generational radiation oncologists were not trained with CT-based planning, these tools were applied to planning and radiation oncologists adjusted the planning process and applied volumetric metrics for daily work. Radiation oncologists had to pivot and alter work flow. Simulation with three-dimensional planning based using CT simulation changed the paradigm of radiation oncology. Effort was made to use historical data for injury to optimize planning for radiation therapy, however volumes had to be estimated and accurate conclusions for dose volume analysis could not be firmly established from previous data. The results for tumor control were excellent and equivalent to mastectomy, therefore radiation therapy was established as an adjunct to breast preserving surgery for primary breast cancer management as well as an invaluable tool in treating multiple clinical situations for this disease (Fisher et al., 2002 Veronesi U et al., 1981 Sarrazin et al., 1989 Blichert-Toft et al., 1992 van Dongen et al., 2000 Jacobson et al., 1995).Īlthough the technique had merit and made good use of available technology at the time, there was no optimal accurate method to capture volume information for both tumor associated targets and normal tissue in the therapy field. The breast contour was taken one plane in the region of the breast isocenter and compensation devices for the slope of the medial and lateral breast were placed to accommodate the slope of the chest wall in this single plane. If nodal regions in the supraclavicular region and axilla were included in the therapy plan, matched non divergent field edges were aligned using multiple techniques to create a match line between the fields treating the breast/chest wall and nodal regions in a single therapy plan. Prior to the development of computed tomography (CT) based volumetric planning, patients were simulated for treatment using fluoroscopy calculated with two-dimensional geometry and isodose distribution only generated through the isocenter of therapy. Radiation therapy for patients with primary breast cancer has significantly changed over the past 50 years. Keywords: Radiation Therapy, Breast Cancer, Volumetric-Based Treatment, Normal Tissue Contraints, Contouring Targets In this paper, we review approaches for contouring targets in breast cancer clinical trials to help site investigators effectively treat targets and meet normal tissue constraints. Today’s breast cancer clinical trials demonstrate the volumetric-based strategies for contouring breast and regional lymph node targets and normal tissue can be common threads as well as points of differentiation. Radiation therapy is an important tool in the care of patients with breast cancer. Giulia Cicchetti, Shirin Sioshansi, Beth Herrick, Jonathan Glanzman, Lakshimi Shanmugham, Thomas Quinn, Shannon Higgins, Julie Trifone, Joshua Taylor, Marious Croos, Bashera Nochomowitz, Linda Taylor, Karen Morano, Kathleen Briggs, Shawn Kirby, Jean Quigley, Heather Reifler, Fran Laurie, Amanda Ignacio, Katherine Karolczuk, TJ FitzGerald Roubil, Matthew Iandoli, Suhong Yu, Jonathan Saleeby, Eric Ko, Daniel Han, Janaki Moni, Allison Sacher, M. Radiation Oncology: Contouring for Patients with Primary Breast Cancer for Clinical Protocol ComplianceĪuthor: Anna Shlimak, Maureen Britton, Maryann Bishop-Jodoin, Linda Ding, Carla Bradford, Harry Bushe, Abdulnasser Khalifei, Fenghong Liu, Kenneth Ulin, Yankua Fan, I-Lin Kuo, John G. FRONTIERS IN MEDICAL CASE REPORTS - Volume 2 Issue 4, (Jul-Aug, 2021)
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