Recent advances in breast cancer radiotherapy: Evolution or revolution, or how to decrease cardiac toxicity?

Table 1 Doses to organs at risk (OAR) according to recommendations of the French Society of Radiation Oncology

Lung	V20 < 15%, V30 < 10%
Heart	< 35 Gy
Liver	V30 < 50%
Spinal cord	< 45 Gy
Esophagus	Maximum 40 Gy in 15 cm
Larynx	< 20%
Thyroid	Must be protected
Brachial plexus	< 55 Gy

Table 2 Simplified rules delineate the lymph node areas before conformal radiotherapy treatment

Supra clavicular region: contouring of the supraclavicular region is guided by the origin of the internal mammary artery

Cranial: Thyroid cartilage

Caudal: Clavicular head

Medial (med): Trachea

Posterior (post)-lateral (lat): Anterior scalene muscle

Post-med: Carotid artery

Infra clavicular region: The infraclavicular region corresponds to lymphatic drainage between axillary vertex and the superior limit of the axillary LN dissection (LND)

Cranial: Pectoralis minor

Caudal: Sternoclavicular joint

Lat: Pectoralis minor (medial side)

Med: Clavicle

Ant: Pectoralis major

Post: Axillary artery

Internal mammary chain: The lymph nodes of the IMC are located within the anterior interspaces; they are located either medially or laterally to the vessels and are concentrated in the upper three interspaces

Ant: Ant. part of the vascular area

Post: The pleura

Med: Medial limit of the vascular area

Lat: Lateral limit of the vascular area

Caudal: Superior side of the 4th rib

Cranial: Inferior limit of supra clavicular area

Rotter LN or intra pectoral node: situated between: pectoralis major and pectoralis minor at the 2nd intercostal space

Axilla

Ant: Pectoralis major & pectoralis minor

Post: Subscapularis, teres major and latissimus dorsi

Med: Seratus anterior

Lat: 5 mm backward the skin

Caudal: 4th and 5th ribs

Cranial: Inferior limit of infraclavicular volume or “first clip” after

sentinel lymph node procedure