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@ARTICLE{Behzadi:302812,
      author       = {S. T. Behzadi and R. Moser and M. Düsberg and M. Aigner
                      and J. Nano and S. Kiesl and J. Lammert and E. Klein and G.
                      P. Schmidt and M. Kiechle and T. Huber and S. Corradini and
                      S. E. Combs$^*$ and K. J. Borm},
      title        = {{P}artial breast irradiation after sentinel lymph node
                      biopsy omission: {I}s it a valid alternative to whole breast
                      {I}rradiation? {A}nalysis of the dose to the sentinel lymph
                      node region during whole breast irradiation vs. partial
                      breast irradiation.},
      journal      = {The breast},
      volume       = {82},
      issn         = {0960-9776},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2025-01352},
      pages        = {104523},
      year         = {2025},
      abstract     = {Sentinel lymph node biopsy (SLNB) can be safely omitted in
                      selected early-stage, clinically node-negative breast cancer
                      (BC) patients. While these patients are also candidates for
                      partial breast irradiation (PBI), the dosimetric effects of
                      PBI on the sentinel lymph node region (SLNs) and axillary
                      levels remain unclear.In this study, SLNs were identified
                      and contoured in 100 BC patients using pre- and
                      postoperative imaging. Axillary levels were contoured
                      following ESTRO guidelines. Dose distribution to the SLN (n
                      = 9000 data points) and axillary levels (n = 270 data
                      points) were analyzed for whole breast irradiation (WBI) and
                      PBI across different techniques (3D-conformal radiation
                      therapy [3D-CRT] vs. volumetric modulated arc therapy
                      [VMAT]), deep inspiration breath-hold [DIBH] vs. free
                      breathing [FB]), and anatomical variations (breast size,
                      tumor site, and upper breast border).WBI provided full
                      therapeutic dose coverage (>95 $\%$ of the prescribed dose)
                      to 65 $\%$ of SLNs, compared to only 10 $\%$ (3D-CRT) and 3
                      $\%$ (VMAT) with PBI. DIBH significantly reduced dose
                      distribution to SLN and axillary levels compared to FB.
                      Lower incidental dose coverage was also observed in patients
                      with medial/central tumors, smaller breasts, and lower upper
                      breast borders.These results demonstrate that PBI delivers
                      substantially lower incidental dose to the SLN than WBI.
                      Since patients in the INSEMA and SOUND trials were
                      predominantly treated with WBI, combining SLNB omission with
                      PBI should not be considered a standard approach and
                      warrants further investigation.},
      keywords     = {Incidental nodal irradiation (Other) / Low-risk breast
                      cancer (Other) / Partial breast irradiation (Other) /
                      Sentinel lymph node biopsy omission (Other) / Whole breast
                      irradiation (Other)},
      cin          = {MU01},
      ddc          = {610},
      cid          = {I:(DE-He78)MU01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40609502},
      doi          = {10.1016/j.breast.2025.104523},
      url          = {https://inrepo02.dkfz.de/record/302812},
}