title: Vessel based delineation guidelines for the elective lymph node regions in breast cancer radiation therapy - PROCAB guidelines.
abstract: OBJECTIVE
  A national project to improve the quality of breast radiation therapy was started, named PROCAB (PROject on CAncer of the Breast). One of the objectives was to reach a national consensus guideline for the delineation of the regional lymph node areas in breast radiation therapy.
  
  
  METHODS
  The realization of the new guidelines was a step by step process that started with multiple expert meetings where the existing guidelines were analyzed and the delineations of the lymph node regions were performed together with a surgeon, specialized in the anatomy of the drainage of the breast.
  
  
  RESULTS
  The delineation guidelines are vessel-based. Since the occurrence of pathological lymph nodes is typically around the veins, the cranial and caudal borders of all different nodal regions are based on a 5mm margin around the veins, except for the parasternal lymph node area. Compared to the existing guidelines there are some major changes.
  
  
  CONCLUSIONS
  With this project a national as well as a European (ESTRO) consensus guideline for the delineation of the regional lymph node areas in breast RT is reached. The new delineation atlas is vessel-based and no longer field-based.
authors.affiliation: University Hospitals Leuven/KU Leuven, Belgium. Electronic address: karolien.verhoeven@uzleuven.be.
authors.forename: Karolien
authors.initials: K
authors.lastname: Verhoeven
authors.affiliation: University Hospitals Leuven/KU Leuven, Belgium.
authors.forename: Caroline
authors.initials: C
authors.lastname: Weltens
authors.affiliation: Clinique Sainte Elisabeth (AMPR), Namur, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Remouchamps
authors.affiliation: Clinique Sainte Elisabeth (AMPR), Namur, Belgium.
authors.forename: Khalil
authors.initials: K
authors.lastname: Mahjoubi
authors.affiliation: Ghent University Hospital, Belgium.
authors.forename: Liv
authors.initials: L
authors.lastname: Veldeman
authors.affiliation: Catholic University of Louvain, Brussels, Belgium.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lengele
authors.affiliation: University Hospitals Leuven/KU Leuven, Belgium.
authors.forename: Eszter
authors.initials: E
authors.lastname: Hortobagyi
authors.affiliation: Catholic University of Louvain, Brussels, Belgium.
authors.forename: Carine
authors.initials: C
authors.lastname: Kirkove
mesh_terms: D001365:Axilla; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000098:blood supply / Q000473:pathology / Q000532:radiotherapy*; D032921:Consensus; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D042361:Mammary Glands, Human; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Breast cancer; Delineation guidelines; Radiation therapy; Regional nodal irradiation