Quality assurance.

Recent data indicates a broad but small absolute advantage of <5% in rates of disease-free survival when regional nodal irradiation (RNI) is employed for certain higher risk breast cancers. How might this be affected in the real world when contours and plans don’t necessarily pass a third-party review? This retrospective look at 161 women receiving RNI within the University of Pittsburgh system aims to determine dosimetric quality as measured against trial standards. In the end, 18% had absent or unacceptable nodal contours, 15% didn’t achieve adequate nodal target volume coverage, 9% had a lung V20Gy >35%, and 3% had a mean heart dose >4 Gy. TBL: Optimizing outcomes with RNI likely calls for peer review. | Ling, Pract Radiat Oncol 2020

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