What guides regional nodal irradiation in node positive breast cancer following upfront sentinel lymph node biopsy?

Putora PM, Henke G, Beşe N, Boersma L, Coles CE, de Boniface J, Duane F, Gabryś D, Jagsi R, Kim K, Kirby AM, Marta GN, Meattini I, Mjaaland I, Montero A, Offersen BV, Ramiah D, Ratoša I, Strnad V, Zeidan YH, Poortmans P, Kaidar-Person O (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 211

Article Number: 111055

DOI: 10.1016/j.radonc.2025.111055

Abstract

Background: This study aimed to evaluate decision-making patterns among international experts regarding breast cancer regional node irradiation (RNI), using an objective, consensus-driven approach. Methods: Twenty-one international radiation oncology experts were invited to participate in a consensus-based evaluation of RNI recommendations. Participants provided responses to clinical scenarios involving early-stage breast (cN0) cancer with sentinel lymph node biopsy (SNLB)-positive findings (pN1a) without completion axillary lymph node dissection (ALND). Decision-making parameters, including patient age, tumour characteristics, and biological risk factors were analysed. Findings: Of the 21 experts, 19 completed the evaluation. Responses included 22 different decision-making criteria and demonstrated considerable variability in decision-making, even after simplifying treatment options. Consensus was most frequently observed in high- and low-risk cases, with comprehensive RNI or omission of RNI being recommended, respectively. However, for intermediate-risk scenarios, no clear agreement was reached reflecting different clinical considerations and assessment of risk factors. Interpretation: Due to many randomised studies investigating different risk factors that do not always coincide, breast cancer experts rely on a wide variety of criteria to recommend RNI for pN1(sn) breast cancer, leading to heterogeneity in decision-making. With this work we aim to raise awareness of this challenge to provoke revision of current guidelines and expert-based recommendations.

Authors with CRIS profile

Involved external institutions

Kantonsspital St.Gallen Switzerland (CH) Spital Thurgau AG Switzerland (CH) Acıbadem Üniversitesi Turkey (TR) Maastricht University Medical Center (UMC+) Netherlands (NL) University of Cambridge United Kingdom (GB) Karolinska Institute Sweden (SE) Saint Luke's Radiation Oncology Network Ireland (IE) Maria Skłodowska-Curie Institute of Oncology / Centrum Onkologii–Instytut im. Marii Skłodowskiej-Curie w Warszawie Poland (PL) Emory University United States (USA) (US) Seoul National University Bundang Hospital (SNUBH) / 분당 서울대병원 Korea, Republic of (KR) Royal Marsden Hospital / The Royal Marsden NHS Foundation Trust United Kingdom (GB) Hospital Sírio-Libanês Brazil (BR) Università degli Studi di Firenze / University of Florence Italy (IT) Stavanger University Hospital Norway (NO) HM Hospitales Spain (ES) Aarhus University Hospital / Aarhus Universitetshospital Denmark (DK) University of the Witwatersrand (WITS) South Africa (ZA) Institute for Oncology Ljubljana (OIL) Slovenia (SI) Baptist Health South Florida United States (USA) (US) University of Antwerp / Universiteit Antwerpen Belgium (BE) Chaim Sheba Medical Center at Tel HaShomer / המרכז הרפואי עש חיים שיבא – תל השומר‎‎ Israel (IL)

How to cite

APA:

Putora, P.M., Henke, G., Beşe, N., Boersma, L., Coles, C.E., de Boniface, J.,... Kaidar-Person, O. (2025). What guides regional nodal irradiation in node positive breast cancer following upfront sentinel lymph node biopsy? Radiotherapy and Oncology, 211. https://doi.org/10.1016/j.radonc.2025.111055

MLA:

Putora, PM M., et al. "What guides regional nodal irradiation in node positive breast cancer following upfront sentinel lymph node biopsy?" Radiotherapy and Oncology 211 (2025).

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