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.
What guides regional nodal irradiation in node positive breast cancer following upfront sentinel lymph node biopsy? / Putora P.M.; Henke G.; Bese N.; Boersma L.; Coles C.E.; de Boniface J.; Duane F.; Gabrys D.; Jagsi R.; Kim K.; Kirby A.M.; Marta G.N.; Meattini I.; Mjaaland I.; Montero A.; Offersen B.V.; Ramiah D.; Ratosa I.; Strnad V.; Zeidan Y.H.; Poortmans P.; Kaidar-Person O.. - In: RADIOTHERAPY AND ONCOLOGY. - ISSN 0167-8140. - ELETTRONICO. - 211:(2025), pp. 111055.0-111055.0. [10.1016/j.radonc.2025.111055]
What guides regional nodal irradiation in node positive breast cancer following upfront sentinel lymph node biopsy?
Kim K.;Meattini I.;
2025
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.
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