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Mid-trial dosimetric analysis of the korean radiation oncology group 19 − 09 multi-institutional prospective cohort study on breast cancer
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DOI：10.1186/s13014-026-02904-y.png)
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Abstract
En 中文
The Korean Radiation Oncology Group 19 − 09 multi-institutional clinical trial investigates the effect of regional nodal irradiation (RNI) omission on regional recurrence rates after neoadjuvant chemotherapy followed by breast-conserving surgery, and sentinel lymph node biopsy in cT1-3N1 and ypN0 breast cancer patients. This mid-trial analysis evaluates dosimetric deviations among enrolled patients using an artificial intelligence (AI) auto-contouring engine. We analyzed dose-volume histograms of 366 patients enrolled from eight institutions based on an AI auto-contoured reference structure set. Of these, 176 received whole breast and regional nodal irradiation (WBI + RNI), while 190 received whole breast irradiation only (WBI). Dosimetric outliers were observed in both groups. In the WBI + RNI group, 25 (14%) and 30 (17%) patients were outliers in D95% of axillary levels II and III, respectively. The corresponding counts in the WBI group were 17 (9%) and 16 (8%), respectively. Especially, 7 (58%) of 12 patients treated by one physician in the WBI + RNI group were outliers for axillary level III. Similarly, among the 49 patients treated by another physician in the WBI + RNI group, 21 (43%) were outliers for axillary level II and 21 (43%) for level III. Regarding the breast CTV, all outlier patients except one were treated by the two physicians. Significant dose deviations were observed, indicating that comparing the WBI + RNI and WBI groups alone may inadequately assess the clinical impact of RNI omission. Therefore, the final analysis will evaluate the association between specific regional nodal doses and clinical outcomes.
Keywords:
Breast cancer
Regional nodal irradiation
Neoadjuvant chemotherapy
Artificial Intelligence
Auto-contouring
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