Breast Cancer Contouring
Breast Cancer Contouring
Breast Cancer Contouring
Dr Susmita Sadhukhan
Registrar A
Radiation Oncology
Another Guideline????????
Target volume delineation : weakest part of the quality
chain in RT.
Large inter-observer variation
Previous Guideline uses same fixed bony landmarks
strong There is no reason to enlarge the
mostly.
radiation
Larger treated volumes even than treated with
conventional simulator-based RT.
fields beyond those obtained with
conventional simulator
Reduce thebased treatment
dose to the OAR set-up
More attention paid to the vessels and less to bony
structures
Materials and methods
The teachers from four countries (DK, ESP, F and NL) continued to
work towards a European consensus on delineation guidelines.
One of the teachers of the ESTRO course started with delineating
relevant CTV.
The three other teachers commented, and specific borders were
discussed during ESTRO courses and at telephone conferences,also
using ESTROs FALCON platform.
Compromise between real anatomical borders and practical clinical
borders to prevent an increase in size of the RT fields compared to
conventional RT fields.
Guidelines were discussed with the Belgium group , and further
adaptations were made
CT Simulation :
Non-contrast-enhanced computer tomography(CT) scans in breast
board inclined at 12.515 with both arms abducted around 120 degree.
The head was positioned straight with the chin slightly upwards,
avoiding skin folds at the level of the lower neck.
Scans were made under free breathing and with 2.5 mm thick sections
CTVp_breast (BCS)
RTOG
ESTRO
Cranial : Upper border of palpable/visible breast tissue; maximally up
to the inferior edge of the sternoclavicular joint
CaudalIrrespective of visible
: Most caudal CT slice with thebreast
position
Ventral : 5 mm under skin surface *
of the primary tumour bed in the
Dorsal : Major pectoral muscle or costae and intercostal muscles
where no muscle. breast,
the
MedialCTVp_breast
: Lateral to the medialmust
perforatingencompasses
mammarian vessels;
maximally to the edge of the sternal bone
the breast
Lateral : Lateral primary tumour
fold; anterior bed artery
to the lateral thoracic
At the caudal part of the breast the dorsal border can be
adjusted in ventro/ventrolateral direction in particular in
obese patients with a thick subcutaneous tissue layer.
Cranial : 2nd rib insertion caudal inferior edge of the
sternoclavicular joint.