ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer

Birgitte V. Offersen*, Liesbeth J. Boersma, Carine Kirkove, Sandra Hol, Marianne C. Aznar, Albert Biete Sola, Youlia M. Kirova, Jean-Philippe Pignol, Vincent Remouchamps, Karolien Verhoeven, Caroline Weltens, Meritxell Arenas, Dorota Gabrys, Neil Kopek, Mechthild Krause, Dan Lundstedt, Tanja Marinko, Angel Montero, John Yarnold, Philip Poortmans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background and purpose: Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. Material and methods: During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. Results: Borders of the CTV encompassing a 5 mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. Conclusion: The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency.
Original languageEnglish
Pages (from-to)3-10
JournalRadiotherapy and Oncology
Issue number1
Publication statusPublished - Jan 2015


  • Breast cancer
  • Lymph nodes
  • Axillary nodes
  • Worldwide consensus
  • Guideline
  • Target volume delineation

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