Radiation Therapy Contouring Guidelines for Breast Cancer

Guideline Recommendations

The National Comprehensive Cancer Network recommends defining target volumes by anatomical regions with prescription depth varying based on patient size 1
The European Society for Radiotherapy and Oncology guidelines specify inclusion of the most caudal lymph nodes surrounding the subclavicular arch and base of jugular vein for supraclavicular CTV 2
For regional nodal irradiation in advanced disease, the European Society for Radiotherapy and Oncology provides the most comprehensive and individualized approach, specifying that in regionally advanced disease, individualization is required 3, 4

CT-based treatment planning is mandatory across all guidelines to identify lung and heart volumes and minimize exposure 1, 3, 4
The National Comprehensive Cancer Network approach accommodates prescription depth variation based on patient size 1

After ALND, the resected axilla should not be irradiated except with clear residual disease, per European Society for Radiotherapy and Oncology recommendations 3, 4
After positive SLNB without ALND, regional RT extent varies: lowest risk receives no RT, intermediate risk receives level 1-2 RT, highest risk receives full level 1-4 RT including internal mammary nodes 3, 4

Target volumes should be based on worst stage pre-treatment or post-treatment characteristics in patients receiving neoadjuvant chemotherapy per NCCN/RTOG approach 1
The European Society for Radiotherapy and Oncology allows individualization based on clinical tumor stage combined with tumor response 3, 4