2.0 0a01660f-38d7-4a50-9b97-641d6b740051 *AOS_Breast_R_hypofx 26Gy 5fx v1 Thorax Breast Right *AOS_Breast_R_hypofx 26 Gy 5Fx AOS sample template - to be copied, reviewed, modified as deemed appropriate, and approved by site physicist Summary: Whole Breast Hypo fx 5 fx to 26 Gy and Boost to Tumor Bed 5fx to 36Gy Reference: FAST-Forward "Randomised clinical trial testing a 1-week course of curative whole breast radiotherapy against a standard 3-week schedule in terms of local cancer control and late adverse effects in patients with early breast cancer" Version 1.2 Created: 10/10/2024 Last updated: 03/10/25/2024 (PHH) - adjusted target P levels and added Dmean to some OARs ************************************************************************ Rx: Phase 1: "The dose prescribed to level 4 and/or axilla should be as follows: Test group 2: 26 Gy in 5 fractions." - FAST-Foward Phase 2: "A sequential tumour bed boost may be added after breast conservation surgery, but dose level (10 Gy or 16 Gy in 2.0 Gy Fr or radiobiological equivalent (from Protocol Version 4.0))" - FAST-Forsward Target Contouring: "The LN PTV is created from the LN CTV by applying an appropriate expansion margin. Suggested margins are 5-10 mm; however for a level 4 region a maximum of 5 mm margin should be applied medially." - FAST-Forward Target Margins: "The lymph node clinical target volume (LN CTV) may include the supraclavicular nodes (defined as level 4 in accordance with the ESTRO nodal outlining consensus guidelines [1]) and/or the axillary chain." - FAST-Forward "An additional structure LN PTV DVH should be created for plan evaluation purposes only, by cropping the LN PTV 5 mm from the skin, lung and field borders to avoid dose calculation in penumbra and build-up regions." - FAST-Forward OAR Contouring: "Brachial Plexus should be outlined for all patients receiving lymph node radiotherapy. The axillary bundle (nerve, artery, and vein) should be identified in the axilla and traced back to the rib cage. In this region the artery should be outlined to represent the brachial plexus, which surrounds this vessel. A 5-mm diameter paint tool can be used to contour the brachial plexus OAR." - FAST-Forward Optimal Objectives: "LN PTV DVH coverage V90% = 90%. V107%< = 2% of LN PTV DVH. V107% <= 2cm3 outside the nodal and breast/chest wall PTV volumes. Maximum point dose should not exceed 110% of the prescribed dose." - FAST-Forward OAR Constraints: "The maximum dose to 0.1cm3 the brachial plexus should not exceed 105% of the prescribed dose. Ipsilateral Lung V30% <= 25%." "The lung and heart normal tissue constraints given in the main trial FAST-Forward planning pack (v. 3 May 2013)." - FAST-Forward ** Additional OAR contraints and objectives are based on clinical judgment. ** Structures have been named according to TG 263. 7088 FMA 3.2 Heart 4294954751 Heart 7309 FMA 3.2 Lung right 4278190335 Lung_R 321497 FMA 3.2 Breast left 4294926079 Breast_L 45244 FMA 3.2 Brachial plexus right 4286264992 BrachialPlex_R 7131 FMA 3.2 Esophagus 4291884032 Esophagus 7647 FMA 3.2 Spinal cord 4278255615 SpinalCord 7394 FMA 3.2 Trachea 4278190335 Trachea R-429EB SRT Clinical target volume 4280918220 WBCTV R-429EB SRT Clinical target volume 4280918220 CWCTV HighRiskNodes 99VMS_STRUCTCODE 1.0 High risk node(s) 4278223103 LNCTV TumorBed 99VMS_STRUCTCODE 1.0 Tumor bed 4286611648 Tumor bed R-429EC SRT Planning target volume 4294901760 PTV Target2 R-429EB SRT Clinical target volume 10 Target3 HighRiskNodes 99VMS_STRUCTCODE 1.0 High risk node(s) 5 Target4 TumorBed 99VMS_STRUCTCODE 1.0 Tumor bed 10 Target1 R-429EB SRT Clinical target volume 10 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items -5 ]]> Target1 5.2 Target2 5.2 Target3 5.2 Target4 5.2 Target5 5.2 VolumeDose ShouldBeMoreOrEqual 95 Relative 95 Relative 1 1 VolumeDose ShouldBeLessOrEqual 5 Relative 105 Relative 4 3 VolumeDose ShouldBeLessOrEqual 2 Relative 107 Relative 4 2 DoseVolume ShouldBeLess 0.03 Absolute 110.00000000000001 Relative 4 1 OAR1 VolumeDose ShouldBeLess 30 Relative 1.5 Absolute 3 2 OAR1 VolumeDose ShouldBeLess 5 Relative 7 Absolute 3 1 OAR1 MeanDose OAR2 VolumeDose ShouldBeLess 15 Relative 8 Absolute 2 1 OAR2 MeanDose OAR4 DoseVolume ShouldBeLessOrEqual 0.1 Absolute 27 Absolute DoseVolume ShouldBeLessOrEqual 0.1 Absolute 27.5 Absolute 2 3 OAR3 DoseVolume ShouldBeLessOrEqual 10 Relative 2 Absolute DoseVolume ShouldBeLessOrEqual 10 Relative 3 Absolute 2 2 OAR3 MeanDose NoNormalization Target4 2 MeanDose ShouldBeMoreOrEqual 100 Relative 2 NoNormalization 1 None 1 None 1 None 1 None 1 None 2 None 2 None 2 None 2 None 2 None