{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:16:22Z","timestamp":1785420982292,"version":"3.56.0"},"reference-count":6,"publisher":"MJH Life Sciences","issue":"2","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cancernetwork.com\/view\/a-multicenter-quality-audit-standardizing-esophageal-contouring-in-postmastectomy-radiotherapy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,12]]},"abstract":"<jats:p>Background: Postmastectomy radiotherapy (PMRT) delivered with volumetric modulated arc therapy (VMAT)\noften results in higher esophageal doses than 3D techniques. Recent dose-toxicity studies recommend limiting the esophageal\nmean dose (Dmean) to less than 11 Gy, based on contours drawn from the cricoid to the carina. In contrast, our network\u2019s autosegmentation\ndelineates the entire esophagus, potentially underestimating dose to clinically relevant upper esophageal\nsegments. This audit evaluated current dose-reporting practices and their implications for toxicity.\nMethods: A multicenter retrospective audit of 43 consecutive PMRT cases (March 10 to May 5, 2025) across 8 centers was\nperformed. All sites recontoured the esophagus using the cricoid-to-carina definition and submitted paired dosimetric values.\nOne center reported grade 2 esophagitis rates in a separate clinical cohort before and after implementing the standardized\ncontouring approach.\nResults: Standardized contouring increased the networkwide mean esophageal dose from 6.1 Gy to 11.7 Gy. The median Dmean\nincreased from 5.7 Gy to 9.6 Gy (P &lt; .001). Sixteen of 42 evaluable patients (38.1%) exceeded the 11-Gy benchmark. In the\nseparate cohort, grade 2 esophagitis decreased from 6 of 7 pre\u2013standard operating procedure (SOP) to 0 of 7 post SOP (P = .004).\nConclusion: Standardizing esophageal contouring improves dose accuracy and is associated with reduced symptomatic\nesophagitis, supporting routine use of cricoid-to-carina contours to enhance toxicity risk assessment in PMRT.\nKeywords: Postmastectomy radiation therapy, esophageal contouring, dosimetric audit, radiation esophagitis, autosegmentation.<\/jats:p>","DOI":"10.46883\/2026.25921068","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T18:14:16Z","timestamp":1775240056000},"page":"10","source":"Crossref","is-referenced-by-count":0,"title":["A Multicenter Quality Audit Standardizing Esophageal Contouring in Postmastectomy Radiotherapy."],"prefix":"10.46883","volume":"40","author":[{"given":"Manjinder","family":"Sidhu","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02a7p6b15","id-type":"ROR","asserted-by":"publisher"}],"name":"American India Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Abrol","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03zqqwp43","id-type":"ROR","asserted-by":"publisher"}],"name":"All India Institute of Medical Sciences, Vijaypur, Jammu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan","family":"Lal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02a7p6b15","id-type":"ROR","asserted-by":"publisher"}],"name":"American India Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumeet","family":"Aggarwal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02a7p6b15","id-type":"ROR","asserted-by":"publisher"}],"name":"American India Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prachi","family":"Kalra","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02a7p6b15","id-type":"ROR","asserted-by":"publisher"}],"name":"American India Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Natte","sequence":"additional","affiliation":[{"name":"American Oncology Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushil","family":"Beriwal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04ehecz88","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Pittsburgh Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"25947","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Duane FK, Kerr A, Wang Z, et al. Exposure of the oesophagus in breast cancer radiotherapy: a systematic review of oesophagus doses published 2010-2020. Radiother Oncol. 2021; 164:261-267. doi: 10.1016\/j.radonc.2021.09.032","DOI":"10.1016\/j.radonc.2021.09.032"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"2. Yaney A, Ayan AS, Pan X, et al. Dosimetric parameters associated with radiation-induced esophagitis in breast cancer patients undergoing regional nodal irradiation. Radiother Oncol. 2021; 155:167-173. doi: 10.1016\/j.radonc.2020.10.042","DOI":"10.1016\/j.radonc.2020.10.042"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"3. Wang DQ, Zhang N, Dong LH, et al. Dose-volume predictors for radiation esophagitis in patients with breast cancer undergoing hypofractionated regional nodal radiation therapy. Int J Radiat Oncol Biol Phys. 2023;117(1):186-197. doi: 10.1016\/j.ijrobp.2023.03.060","DOI":"10.1016\/j.ijrobp.2023.06.1101"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"4.  Alsaihaty Z, Manan HA, Sabarudin A, et al. Hybrid Treatment Planning for Chest Wall Irradiation Utilizing Three-Dimensional Conformal Radiotherapy (3DCRT), Intensity-Modulated Radiation Therapy (IMRT), and Volumetric Modulated Arc Therapy (VMAT): A Systematic Review. Cureus. 2024 May 3;16(5): e59583. Doi: 10.7759.","DOI":"10.7759\/cureus.59583"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"5. Jimenez RB, Abdou Y, Anderson P, et al. Postmastectomy radiation therapy: an ASTRO-ASCO-SSO Clinical Practice Guideline. J Clin Oncol. 2025;43(30):3292-3311. doi:10.1200\/JCO-25-01747","DOI":"10.1200\/JCO-25-01747"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"6. Wang DQ, Yan L, Wu HF, et al. Prospective cohort study to validate esophageal dose constraints and predictive models for esophagitis in patients with breast cancer undergoing hypofractionated regional nodal radiotherapy. Radiother Oncol. 2025; 212:111120. doi: 10.1016\/j.radonc.2025.111120","DOI":"10.1016\/j.radonc.2025.111120"}],"container-title":["ONCOLOGY"],"original-title":[],"deposited":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T18:14:21Z","timestamp":1775240061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cancernetwork.com\/view\/a-multicenter-quality-audit-standardizing-esophageal-contouring-in-postmastectomy-radiotherapy"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":6,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,3,16]]},"published-print":{"date-parts":[[2026,3,12]]}},"URL":"https:\/\/doi.org\/10.46883\/2026.25921068","relation":{},"ISSN":["0890-9091","2767-7389"],"issn-type":[{"value":"0890-9091","type":"print"},{"value":"2767-7389","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]}}}