@article{7b250c075cd2475fba3ae44108b6d5b0,
title = "Quality assurance of radiation therapy after breast-conserving surgery among patients in the BOOG 2013-08 trial",
abstract = "Background and purpose: In the BOOG 2013-08 trial (NCT02271828), cT1-2N0 breast cancer patients were randomized between breast conserving surgery with or without sentinel lymph node biopsy (SLNB) followed by whole breast radiotherapy (WBRT). While awaiting primary endpoint results (axillary recurrence rate), this study aims to perform a quality assurance analysis on protocol adherence and (incidental) axillary radiation therapy (RT) dose. Materials and methods: Patients were enrolled between 2015 and 2022. Data on prescribed RT and (in 25% of included patients) planning target volumes (PTV) parameters were recorded for axillary levels I-IV and compared between treatment arms. Multivariable linear regression analysis was performed to determine prognostic variables for incidental axillary RT dose. Results: 1,439/1,461 included patients (98.5%) were treated according to protocol and 87 patients (5.9%) received regional RT (SLNB 10.9%, no-SLNB 1.5 %). In 326 patients included in the subgroup analysis, the mean incidental PTV dose at axilla level I was 59.5% of the prescribed breast RT dose. In 5 patients (1.5%) the mean PTV dose at level I was =95% of the prescribed breast dose. No statistically or clinically significant differences regarding incidental axillary RT dose were found between treatment arms. Tumour bed boost (yes/no) was associated with a higher incidental mean dose in level I (R2 = 0.035, F(6, 263) = 1.532, p 0.168). Conclusion: The results indicate that RT-protocol adherence was high, and that incidental axillary RT dose was low in the BOOG 2013-08 trial. Potential differences between treatmentarms regarding the primary endpoint can thus not be attributed to different axillary radiation doses.",
keywords = "(omission of) sentinel lymph node biopsy, Axillary treatment, Breast cancer, Incidental RT dose, Radiation therapy quality assurance",
author = "Wintraecken, {V. M.} and Boersma, {L. J.} and {van Roozendaal}, {L. M.} and {de Vries}, J. and {van Kuijk}, {S. M.J.} and Vane, {M. L.G.} and {van Dalen}, T. and {van der Hage}, {J. A.} and Strobbe, {L. J.A.} and Linn, {S. C.} and Lobbes, {M. B.I.} and Poortmans, {P. M.P.} and Tjan-Heijnen, {V. C.G.} and {van de Vijver}, {K. K.B.T.} and Westenberg, {A. H.} and {de Wilt}, {J. H.W.} and Smidt, {M. L.} and Simons, {J. M.}",
note = "Funding Information: The BOOG 203-08 trial received funding from the Dutch Cancer Society (UM 2014-6679) and ZonMw (843002624). The funding sources had no involvement in (the design of) the BOOG 2013-08 trial or in the preparation of this manuscript. The authors gratefully thank the following surgeons and research-nurses for the patient inclusion: R.J. Schipper (Catharina Ziekenhuis), Y. van Riet (Catharina Ziekenhuis), J. Bloemen (Catharina Ziekenhuis Eindhoven), J.W.S. Merkus (HagaZiekenhuis), I. Jannink (HagaZiekenhuis), M.F. Bouwmeester (Isala), E.M. Noorda (Isala), A.B. Francken (Isala), M. Bessems (Jeroen Bosch Ziekenhuis), A.V.R.J. Bell (Laurentius Ziekenhuis), M.F. Sier (Rivierenland Ziekenhuis/ St. Antonius Ziekenhuis), N. Vermulst (Rivierenland Ziekenhuis/ St. Antonius Ziekenhuis), R.R.J.P. van Eekeren (Rijnstate), C.F.J.M. Blanken-Peeters (Rijnstate), R. Koelemij (St. Antonius Ziekenhuis), F. Aarts (VieCuri Medisch Centrum), P.H. Nijhuis (VieCuri Medisch Centrum), and T. Schok (VieCuri Medisch Centrum). Also a special thanks to the following radiation oncologists for their support in the radiation data collection of the BOOG2013-08 study: M. Schippers (Bernard Verbeeten Instituut), M.J.C. van der Sangen (Catharina Ziekenhuis), P.P. van der Toorn (Catharina Ziekenhuis), J. Theuws (Catharina Ziekenhuis), G. Speijer (HagaZiekenhuis), B. Hollmann (HagaZiekenhuis), E.M.A. Roeloffzen (Isala), L. Zwanenburg (Isala), E. Phernambucq (Isala), A. Smid-Dam (Isala), G. de Jong (Isala), E.J.F. van Reij (Leids Universitair Medisch Centrum), S.M. de Boer (Leids Universitair Medisch Centrum), A. Scholten (Netherlands Cancer Institute), P. Westhoff (Radboud Medisch Centrum), M.R. Stam (Radiotherapiegroep Arnhem/ Ede), D.M. Busz (Universitair Medisch Centrum Groningen), F. van der Leij (Universitair Medisch Centrum Utrecht), and E. van Enckevoort (Maastro). The authors gratefully thanks the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of the data for the Netherlands Cancer Registration. We would also like to express our gratitude to Jessica van Raaij-Kandt and Larissa Hiddink-Emelianova from IKNL for their assistance on this project. Funding Information: The BOOG 203-08 trial received funding from the Dutch Cancer Society ( UM 2014-6679 ) and ZonMw ( 843002624 ). The funding sources had no involvement in (the design of) the BOOG 2013-08 trial or in the preparation of this manuscript. Publisher Copyright: {\textcopyright} 2023 The Author(s)",
year = "2024",
month = feb,
day = "1",
doi = "10.1016/j.radonc.2023.110069",
language = "English",
volume = "191",
journal = "Radiotherapy and Oncology",
issn = "0167-8140",
publisher = "Elsevier Ireland Ltd",
}