title: ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer.
abstract: OBJECTIVE
  Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists.
  
  
  METHODS
  During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions.
  
  
  RESULTS
  Borders of the CTV encompassing a 5mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer.
  
  
  CONCLUSIONS
  The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency.
authors: Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: birgoffe@rm.dk.
authors: Birgitte V
authors: BV
authors: Offersen
authors: Department of Radiation Oncology, Maastricht University Medical Centre - GROW (MAASTRO), The Netherlands.
authors: Liesbeth J
authors: LJ
authors: Boersma
authors: Department of Radiation Oncology, Catholic University of Louvain, Belgium.
authors: Carine
authors: C
authors: Kirkove
authors: Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands.
authors: Sandra
authors: S
authors: Hol
authors: Department of Oncology, Rigshospitalet, Copenhagen, Denmark.
authors: Marianne C
authors: MC
authors: Aznar
authors: Department of Radiation Oncology, Hospital Clinic i Provincial, Barcelona, Spain.
authors: Albert
authors: A
authors: Biete Sola
authors: Department of Radiation Oncology, Institut Curie, Paris, France.
authors: Youlia M
authors: YM
authors: Kirova
authors: Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Jean-Philippe
authors: JP
authors: Pignol
authors: Department of Radiation Oncology, Clinique Sainte Elisabeth (AMPR), Namur, Belgium.
authors: Vincent
authors: V
authors: Remouchamps
authors: Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium.
authors: Karolien
authors: K
authors: Verhoeven
authors: Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium.
authors: Caroline
authors: C
authors: Weltens
authors: Department of Radiation Oncology, Hospital Universitari Sant Joan, Reus, Spain.
authors: Meritxell
authors: M
authors: Arenas
authors: Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice, Poland.
authors: Dorota
authors: D
authors: Gabrys
authors: Department of Oncology, Division of Radiation Oncology, McGill University, Montréal, Canada.
authors: Neil
authors: N
authors: Kopek
authors: German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ) Heidelberg, Dept. of Radiation Oncology and OncoRay, University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
authors: Mechthild
authors: M
authors: Krause
authors: Department of Oncology, Sahlgrenska Universitetssjukhuset, Gothenborg, Sweden.
authors: Dan
authors: D
authors: Lundstedt
authors: Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
authors: Tanja
authors: T
authors: Marinko
authors: Department of Radiation Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario Sanchinarro, Madrid, Spain.
authors: Angel
authors: A
authors: Montero
authors: Division of Radiotherapy and Imaging, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK.
authors: John
authors: J
authors: Yarnold
authors: Department of Radiation Oncology, Radboud university medical centre, The Netherlands.
authors: Philip
authors: P
authors: Poortmans
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D032921:Consensus; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control; D015588:Observer Variation; D015641:Radiography, Interventional / Q000379:methods; D061089:Radiotherapy, Image-Guided / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000592:standards
keywords: Axillary nodes; Breast cancer; Guideline; Lymph nodes; Target volume delineation; Worldwide consensus