ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer

Radiother Oncol. 2015 Jan;114(1):3-10. doi: 10.1016/j.radonc.2014.11.030. Epub 2015 Jan 24.


Background and purpose: 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.

Material and 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.

Conclusion: 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.

Keywords: Axillary nodes; Breast cancer; Guideline; Lymph nodes; Target volume delineation; Worldwide consensus.

Publication types

  • Practice Guideline

MeSH terms

  • Axilla
  • Breast Neoplasms / pathology
  • Breast Neoplasms / radiotherapy*
  • Consensus
  • Female
  • Humans
  • Lymph Nodes / pathology
  • Lymphatic Metastasis
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / prevention & control
  • Observer Variation
  • Radiography, Interventional / methods
  • Radiotherapy, Image-Guided / methods
  • Tomography, X-Ray Computed / standards