Vessel based delineation guidelines for the elective lymph node regions in breast cancer radiation therapy - PROCAB guidelines

Radiother Oncol. 2015 Jan;114(1):11-6. doi: 10.1016/j.radonc.2014.11.008. Epub 2014 Nov 19.


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.

Conclusion: 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.

Keywords: Breast cancer; Delineation guidelines; Radiation therapy; Regional nodal irradiation.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Axilla
  • Breast / pathology
  • Breast Neoplasms / blood supply
  • Breast Neoplasms / pathology
  • Breast Neoplasms / radiotherapy*
  • Consensus
  • Female
  • Humans
  • Lymph Nodes / pathology
  • Lymphatic Metastasis
  • Mammary Glands, Human
  • Retrospective Studies
  • Tomography, X-Ray Computed