Details of a Researcher - Sanuki, Naoko

Papers - Sanuki, Naoko

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全肝照射により多発肝転移が縮小した治療抵抗性の進展型小細胞肺癌の1例

児玉秀治, 吉田正道, 三木寛登, 後藤広樹, 増田和記, 藤原篤司, 南平結衣, 佐貫直子, 後藤大基, 鶴賀龍樹

肺癌 ((NPO)日本肺癌学会) 63 ( 7 ) 959 - 964 2023.12

ISSN 0386-9628

背景.肝転移は小細胞肺癌で発生頻度が高く予後不良因子である.近年,海外を中心に肝臓への緩和照射の有用性が報告されているが,国内で報告例は少なく普及していない.症例.76歳男性.進展型小細胞肺癌に対し20XX-1年6月下旬からカルボプラチン+エトポシド+デュルバルマブ療法を開始,6コース完遂後にデュルバルマブ維持療法中だった.原発巣,肝転移,傍大動脈リンパ節転移の増大のため20XX年2月下旬に治療変更目的に入院した.Sensitive relapseと考えカルボプラチン+エトポシド療法を行ったが,背部痛と黄疸が出現し増強,オピオイドを開始した.多発肝転移増大に伴う被膜伸展症状であり疼痛緩和目的の全肝照射(21Gy/7fr)を行った.フレア現象で一過性疼痛増強がありオピオイドやステロイドを一時増量したが速やかに症状は軽快し独歩退院した.再入院しアムルビシン療法へ変更,全肝照射終了から約1ヵ月時点で症状は軽快し多発肝転移も縮小している.結論.小細胞肺癌は放射線感受性が高く,低線量照射で効果が得られた.低線量では放射線肝障害が起こりにくく全肝照射は治療抵抗性の小細胞肺癌でも有用と考える.(著者抄録)

Tailored axillary surgery (TAS) in patients with clinically node-positive breast cancer in the upfront surgery setting: A prospective, single-arm, multicenter trial

Terata, K; Sagara, Y; Shien, T; Sakai, T; Takayama, S; Kitagawa, D; Iwatani, T; Tsukioki, T; Ogita, M; Sanuki, N; Yoshida, M; Tsuda, H; Yamamoto, S; Iwata, H

JOURNAL OF CLINICAL ONCOLOGY 41 ( 16 ) 2023.06

ISSN 0732-183X

Local control correlates with overall survival in radiotherapy for early-stage non-small cell lung cancer: A systematic review

Sanuki N., Takeda A., Eriguchi T., Tsurugai Y., Tateishi Y., Kibe Y., Akiba T., Fukuzawa T., Horita N.

Radiotherapy and Oncology 183 109664 2023.06

ISSN 01678140

Purpose: Local control (LC) is an important outcome of local cancer therapy, besides overall survival (OS). We conducted a comprehensive literature search to investigate whether a high LC rate contributes to good OS in radiotherapy for early-stage non-small cell lung cancer (ES-NSCLC). Materials and methods: Studies in patients receiving radiotherapy for peripheral ES-NSCLC, mainly staged as T1-2N0M0 were included for a systematic review. Relevant information was collected including, dose fractionation, T stage, median age, 3-year LC, cancer-specific survival (CSS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and OS. Correlations between outcomes and clinical variables were evaluated. Results: After screening, 101 data points from 87 studies including 13,435 patients were selected for the quantitative synthesis. Univariate meta-regression analysis revealed that the coefficients between the 3-year LC and 3-year DFS, DMFS, CSS, and OS were 0.753 (95% confidence interval (CI): 0.307–1.199; p < 0.001), 0.360 (95% CI: 0.128–0.593; p = 0.002), 0.766 (95% CI: 0.489–1.044; p < 0.001), and 0.574 (95% CI: 0.275–0.822; p < 0.001), respectively. Multivariate analysis revealed that the 3-year LC (coefficient, 0.561; 95% CI: 0.254–0.830; p < 0.001) and T1 proportion (coefficient, 0.207; 95% CI: 0.030–0.385; p = 0.012) were significantly associated with the 3-year OS and CSS (coefficient for 3-year LC, 0.720; 95% CI: 0.468–0.972; p < 0.001 and T1 proportion, 0.002; 95% CI: 0.000–0.003; p = 0.012). Toxicities ≥ grade 3 were low (3.4%). Conclusions: Three-year LC was correlated with three-year OS in patients receiving radiotherapy for ES-NSCLC. A 5% increase in 3-year LC is expected to improve the 3-year CSS and OS rates by 3.8% and 2.8%, respectively.

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Symptom palliation with QUAD Shot radiation therapy to penile metastasis derived from descending colon cancer: a case report

Yamamoto, A; Ieki, H; Shimamura, M; Tsujiura, M; Yokoe, T; Sanuki, N; Ojima, E; Uchida, K; Mohri, Y

International Cancer Conference Journal 12 ( 3 ) 210 - 215 2023.03

ISSN 2192-3183

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【Oligometastasesの最新知見2023】肝oligometastasesに対する定位放射線治療　case based review

佐貫直子, 武田篤也, 江里口貴久, 鶴貝雄一郎

臨床放射線 (金原出版(株)) 68 ( 3 ) 257 - 265 2023.03

ISSN 0009-9252

放射線治療によりリンパ浮腫が改善し一時退院が可能となった肺扁平上皮がん後腹膜リンパ節転移の1例

児玉秀治, 佐貫直子, 酒井美紀子, 山川智一, 宮本翔子, 藤井稚奈, 秦いづみ, 北山智美, 今出雅博, 吉田正道

Palliative Care Research ((NPO)日本緩和医療学会) 18 ( 2 ) 111 - 116 2023

症例は73歳女性.肺扁平上皮がん(cT3N3M0-Stage IIIC)に対し当科治療中.2022年6月より肺がん進行に伴い後腹膜リンパ節転移による腰背部痛が増強した.疼痛以外に両下肢浮腫による体動困難もあり7月8日に緊急入院し,後腹膜リンパ節転移に対して放射線治療(30Gy/10fr)を行った.タペンタドール200mg/日で疼痛管理を行っていたが入院中にフェンタニル貼付剤1200μg/日へ変更し腰背部痛は軽減した.また浮腫の原因疾患を鑑別し,理学所見・検査所見や病歴から,後腹膜リンパ節転移に関連したリンパ浮腫と診断した.入院31日目に浮腫は改善し,ベッド周囲のADLが向上し一時退院可能となった.リンパ節転移に関連したリンパ浮腫の治療方法は確立されておらず,放射線治療の有効性が報告されている.リンパ浮腫の診断に至るまでに他の病態を鑑別し,放射線治療によりリンパ浮腫が改善した1例を報告する.(著者抄録)

Role of stereotactic body radiotherapy in multidisciplinary management of liver metastases in patients with colorectal cancer

Sanuki N., Takeda A., Tsurugai Y., Eriguchi T.

Japanese Journal of Radiology 40 ( 10 ) 1009 - 1016 2022.10

ISSN 18671071

In the treatment of colorectal cancer patients with distant metastases, the development of new anticancer agents has considerably prolonged progression-free survival. Such survival benefits attributed to chemotherapy have increased the relative significance of local therapy in patients with limited metastases. The liver is recognized as the most common site of metastasis of colorectal cancer because of the intestinal mesenteric drainage to the portal veins. Hepatic resection of isolated liver metastases of colorectal cancer is the only option for a potential cure. However, hepatic metastases are resectable in only approximately 20% of the patients. For remaining patients with high-risk resectable liver metastases or those who are unfit for surgery, less invasive, local therapies including radiation therapy (stereotactic body radiation therapy, SBRT) may have a potential role in treatment. Although the local control rate of SBRT for colorectal liver metastases has room for improvement, its less-invasive nature and broad indications deserve consideration. Future research should include SBRT dose escalation or the selection of patients who benefit from local ablative therapies. SBRT may offer an alternative, non-invasive approach for the treatment of colorectal liver metastases in a multidisciplinary treatment strategy.

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Relationship between Dose Prescription Methods and Local Control Rate in Stereotactic Body Radiotherapy for Early Stage Non-Small-Cell Lung Cancer: Systematic Review and Meta-Analysis

Eriguchi T., Takeda A., Nemoto T., Tsurugai Y., Sanuki N., Tateishi Y., Kibe Y., Akiba T., Inoue M., Nagashima K., Horita N.

Cancers 14 ( 15 ) 2022.08

ISSN 2072-6694

Variations in dose prescription methods in stereotactic body radiotherapy (SBRT) for early stage non-small-cell lung cancer (ES-NSCLC) make it difficult to properly compare the outcomes of published studies. We conducted a comprehensive search of the published literature to summarize the outcomes by discerning the relationship between local control (LC) and dose prescription sites. We systematically searched PubMed to identify observational studies reporting LC after SBRT for peripheral ES-NSCLC. The correlations between LC and four types of biologically effective doses (BED) were evaluated, which were calculated from nominal, central, and peripheral prescription points and, from those, the average BED. To evaluate information on SBRT for peripheral ES-NSCLC, 188 studies were analyzed. The number of relevant articles increased over time. The use of an inhomogeneity correction was mentioned in less than half of the articles, even among the most recent. To evaluate the relationship between the four BEDs and LC, 33 studies were analyzed. Univariate meta-regression revealed that only the central BED significantly correlated with the 3-year LC of SBRT for ES-NSCLC (p = 0.03). As a limitation, tumor volume, which might affect the results of this study, could not be considered due to a lack of data. In conclusion, the central dose prescription is appropriate for evaluating the correlation between the dose and LC of SBRT for ES-NSCLC. The standardization of SBRT dose prescriptions is desirable.

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Applying Artificial Neural Networks to Develop a Decision Support Tool for Tis-4N0M0 Non-Small-Cell Lung Cancer Treated With Stereotactic Body Radiotherapy

Nemoto T., Takeda A., Matsuo Y., Kishi N., Eriguchi T., Kunieda E., Kimura R., Sanuki N., Tsurugai Y., Yagi M., Aoki Y., Oku Y., Kimura Y., Han C., Shigematsu N.

JCO Clinical Cancer Informatics 6 e2100176 2022.06

ISSN 2473-4276

PURPOSE: Clear evidence indicating whether surgery or stereotactic body radiation therapy (SBRT) is best for non-small-cell lung cancer (NSCLC) is lacking. SBRT has many advantages. We used artificial neural networks (NNs) to predict treatment outcomes for patients with NSCLC receiving SBRT, aiming to aid in decision making. PATIENTS AND METHODS: Among consecutive patients receiving SBRT between 2005 and 2019 in our institution, we retrospectively identified those with Tis-T4N0M0 NSCLC. We constructed two NNs for prediction of overall survival (OS) and cancer progression in the first 5 years after SBRT, which were tested using an internal and an external test data set. We performed risk group stratification, wherein 5-year OS and cancer progression were stratified into three groups. RESULTS: In total, 692 patients in our institution and 100 patients randomly chosen in the external institution were enrolled. The NNs resulted in concordance indexes for OS of 0.76 (95% CI, 0.73 to 0.79), 0.68 (95% CI, 0.60 to 0.75), and 0.69 (95% CI, 0.61 to 0.76) and area under the curve for cancer progression of 0.80 (95% CI, 0.75 to 0.84), 0.72 (95% CI, 0.60 to 0.83), and 0.70 (95% CI, 0.57 to 0.81) in the training, internal test, and external test data sets, respectively. The survival and cumulative incidence curves were significantly stratified. NNs selected low-risk cancer progression groups of 5.6%, 6.9%, and 7.0% in the training, internal test, and external test data sets, respectively, suggesting that 48% of patients with peripheral Tis-4N0M0 NSCLC can be at low-risk for cancer progression. CONCLUSION: Predictions of SBRT outcomes using NNs were useful for Tis-4N0M0 NSCLC. Our results are anticipated to open new avenues for NN predictions and provide decision-making guidance for patients and physicians.

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Radiation Therapy for Malignant Lumbosacral Plexopathy: A Case Series

Sanuki, N; Kodama, S; Seta, H; Sakai, M; Watanabe, H

Cureus 14 ( 1 ) e20939 2022.01

ISSN 2168-8184

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【改訂:肝癌診療ガイドライン】肝細胞癌に対する放射線療法

木部優一, 佐貫直子, 江里口貴久, 竹中亮介, 渋谷圭, 井垣浩, 水本斉志, 武田篤也, 櫻井英幸

消化器・肝臓内科 ((有)科学評論社) 11 ( 1 ) 117 - 125 2022.01

ISSN 2432-3446

Dynamic conformal arc radiotherapy for locally advanced lung cancer: a comparison with static-beam conformal radiotherapy

Goto M., Sanuki N., Kasae M., Terabayashi R., Nishiwaki Y., Ogita Y., Tone J., Seta H.

Reports of Practical Oncology and Radiotherapy 27 ( 5 ) 897 - 904 2022

ISSN 15071367

Background: This study investigated whether the dose distribution of lung cancer can be improved by dynamic arc conformal radiotherapy (dynamic CRT) compared with static multiple-beam radiotherapy (static CRT). Materials and methods: A dummy study of static CRT and dynamic CRT was performed, designed to meet the predetermined dose constraints. A dose of 60 Gy in 30 fractions was administered using two dose prescription methods: dose prescribed to the isocenter (IC prescription), and dose prescribed to > 50% of the planning target volume (D50 prescription). Dose–volume parameters were compared between the plans. Results: Among 20 patients with locally advanced lung cancer, dose conformity was significantly better with dynamic CRT than static CRT (median conformity index: 1.3 vs. 2.2; p < 0.01). As for the lung dose, compared with static CRT, dynamic CRT did not increase the percentage lung volume receiving ≥ 20 Gy (18.9% vs. 19.3%, p = 0.09). The maximum spinal cord dose was significantly reduced by dynamic CRT (static vs. dynamic CRT: 44.1 vs. 25.2 Gy, p < 0.001). With the change from IC to D50 prescription, the 95% isodose volume increased by 18.3 cc in static CRT and by 4.1 cc in dynamic CRT, while doses to the lung and spinal cord remained within the acceptable ranges. Conclusion: The dynamic CRT technique showed better target coverage and lower doses to the spinal cord in exchange for increased low-dose lung area, compared with static CRT. Dynamic CRT with D50 prescription instead of prescription to the isocenter has excellent dose distribution profiles without compromising doses to organs at risk for lung cancer at favorable locations.

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In Regard to Lee et al.

Eriguchi T., Takeda A., Kimura Y., Sanuki N.

International Journal of Radiation Oncology*Biology*Physics 111 ( 4 ) 1088 - 1089 2021.11

ISSN 0360-3016

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Three Cases of Hepatocellular Carcinoma With Massive Macrovascular Invasion Successfully Treated With Radiotherapy

Tsurugai, Y; Takeda, A; Sanuki, N; Eriguchi, T; Ueno, M

Cureus 13 ( 10 ) e18624 2021.10

ISSN 2168-8184

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Stereotactic Body Radiation Therapy With a High Maximum Dose Improves Local Control, Cancer-Specific Death, and Overall Survival in Peripheral Early-Stage Non-Small Cell Lung Cancer

Tateishi Y., Takeda A., Horita N., Tsurugai Y., Eriguchi T., Kibe Y., Sanuki N., Kaneko T.

International Journal of Radiation Oncology Biology Physics 111 ( 1 ) 143 - 151 2021.09

ISSN 03603016

Purpose: We investigated whether delivery of a high biologically effective dose (BED) to primary tumors affects systemic outcomes of cancer-specific death (CSD) and overall survival (OS) rates after stereotactic body radiation therapy (SBRT) in patients with early-stage non-small cell lung cancer (ES-NSCLC). Methods and Materials: Among consecutive ES-NSCLC patients treated with SBRT between 2005 and 2019, we retrospectively identified patients who received a prescription of 50 to 60 Gy in 5 fractions with maximum doses of 62.5 to 100 Gy. Patients were categorized by maximum BED within the planning target volume with a threshold dose of 200 Gy. Outcomes were analyzed in all and matched patients. Results: Overall, 433 patients were eligible, and 262 and 171 patients were categorized into HighBED and LowBED groups, respectively. After propensity score matching, pairs of 154 patients were selected. Median follow-up times for the HighBED and LowBED groups were 52.3 months (range, 0.8-107.2 months) and 121.6 months (range, 3.0-162.8 months), respectively. The local recurrence rate in the HighBED group was significantly lower than that in the LowBED group (5-year rate, 1.3% and 7.2%; hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.03-0.65; P = .011). Rates of any recurrence and CSD in the HighBED group were significantly lower (5-year any recurrence: 18.1% and 32.1%; HR, 0.52; 95% CI, 0.33-0.83; P = .0058; 5-year CSD: 9.5% and 21.8%; HR, 0.38; 95% CI, 0.20-0.70; P = .002), and OS in the HighBED group was significantly better compared with the LowBED group (5-year rate: 61.7% and 51.8%; HR, 0.71; 95% CI, 0.50-1.00; P = .047). Conclusion: In patients with peripheral ES-NSCLC, SBRT with a high maximum dose may improve not only local control, but also any recurrence, CSD, and OS rates without increased toxicity. Further trials designed to evaluate whether higher intensity SBRT increases local control rates and contributes to improved CSD and OS outcomes are anticipated.

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Comparison of stereotactic body radiotherapy and radiofrequency ablation for hepatocellular carcinoma: Systematic review and meta-analysis of propensity score studies

Eriguchi T., Takeda A., Tateishi Y., Tsurugai Y., Sanuki N., Ebinuma H., Horita N.

Hepatology Research 51 ( 7 ) 813 - 822 2021.07

ISSN 13866346

Aim: Stereotactic body radiotherapy (SBRT) is an emerging treatment for hepatocellular carcinoma (HCC) and has shown excellent local control (LC), as has radiofrequency ablation (RFA). As no randomized controlled trial has compared SBRT and RFA for HCC, data from a propensity score matched study (PSMS) are valuable. However, the results varied greatly and depended on composing factors of Barcelona Clinic Liver Cancer staging (BCLC-factors) adjusted. Therefore, we undertook a systematic review and meta-analyses of the studies focusing on BCLC-factors matching. Methods: We systematically searched PubMed, the Cochrane database, EMBASE, and Web of Science to identify studies comparing RFA and SBRT using propensity scores. The hazard ratios (HRs) of overall survival (OS) and LC from BCLC-factor-matched and -unmatched PSMS were pooled. Heterogeneity between the data from these studies was assessed. Results: Three BCLC-factor-matched studies were identified. Stereotactic body radiotherapy led to comparable OS (HR, 0.89; 95% CI, 0.74–1.08; p = 0.24; I2 = 0%; p for heterogeneity, 0.56) and significantly better LC (HR, 0.39; 95% CI, 0.30–0.51; p < 0.001; I2 = 0%; p for heterogeneity, 0.67). We also identified three additional BCLC-factor-unmatched studies (HR of OS, 1.41; 95% CI, 1.21–1.65; p < 0.0001; I2 = 0%; p for heterogeneity, 0.63). However, considerable heterogeneity was observed for HR of OS between BCLC-factor-matched and -unmatched studies (I2 = 92.6%; p for heterogeneity, 0.0002). Conclusions: When BCLC-factors were properly adjusted, the results of the meta-analysis revealed equivalent OS and better LC for SBRT compared with RFA. Stereotactic body radiotherapy could be an alternative treatment option for HCC.

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Correction to: The Japanese Breast Cancer Society Clinical Practice Guideline for radiation treatment of breast cancer, 2018 edition

Yamauchi C., Yoshimura M., Sekiguchi K., Hamamoto Y., Nakajima N., Sanuki N., Ogo E., Oguchi M., Saji S., Iwata H.

Breast Cancer 28 ( 4 ) 988 - 988 2021.07

ISSN 1340-6868

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Multicenter prospective study of stereotactic body radiotherapy for previously untreated solitary primary hepatocellular carcinoma: The STRSPH study

Kimura T., Takeda A., Sanuki N., Ariyoshi K., Yamaguchi T., Imagumbai T., Katoh N., Eriguchi T., Oku Y., Ozawa S., Tsurugai Y., Kokubo M., Shimizu S., Ishikura S.

Hepatology Research 51 ( 4 ) 461 - 471 2021.04

ISSN 13866346

Aim: To prospectively evaluate the efficacy and safety of stereotactic body radiotherapy (SBRT) for patients with previously untreated solitary primary hepatocellular carcinoma (HCC). Methods: The main eligibility criteria included the following: (1) primary solitary HCC; (2) no prior treatment for HCC; (3) Child–Turcotte–Pugh score of seven or less; and (4) unsuitability for or refusal of surgery and radiofrequency ablation (RFA). The prescribed dose of SBRT was 40 Gy in five fractions. The primary endpoint was 3-year overall survival (OS); the secondary endpoints included local progression-free survival (LPFS), local control (LC), and adverse events. The accrual target was 60 patients, expecting a 3-year OS of 70% with a 50% threshold. Results: Between 2014 and 2018, 36 patients were enrolled; enrollment was closed early because of slow accrual. The median tumor size was 2.3 cm. The median follow-up at the time of evaluation was 20.8 months. The 3-year OS was 78% (95% confidence interval [CI]: 53%–90%). The 3-year LPFS and LC proportion were 73% (95% CI: 48%–87%) and 90% (95% CI: 65%–97%), respectively. Grade 3 or higher SBRT-related toxicities were observed in four patients (11%), and grade five toxicities were not observed. Conclusions: This study showed acceptably low incidence of SBRT-related toxicities. LC and OS after SBRT were comparable for previously untreated solitary HCC for patients unfit for resection and RFA. Although a definitive conclusion cannot be drawn by this study, the promising results indicate that SBRT may be an alternative option in the management of early HCC.

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Hypofractionated radiotherapy for hepatocellular carcinomas adjacent to the gastrointestinal tract

Tsurugai Y., Takeda A., Eriguchi T., Sanuki N., Aoki Y.

Hepatology Research 51 ( 3 ) 294 - 302 2021.03

ISSN 13866346

Aim: Decisions regarding therapeutic plans for inoperable patients with hepatocellular carcinoma (HCC) adjacent to the gastrointestinal (GI) tract are challenging because radiofrequency ablation has the potential risk of thermal injury. Moreover, the response rate of transcatheter arterial chemoembolization is relatively low and stereotactic body radiotherapy (SBRT) is believed to be too toxic. We have applied hypofractionated radiotherapy (HFRT) for such lesions. This study investigated the outcomes and toxicities of this treatment. Methods: Among consecutive HCC patients treated with radiotherapy with curative intent at our institution between 2015 and 2019, we retrospectively extracted those outside of the indication for SBRT due to exceeding the constraint of the GI tract and who were treated using HFRT with a prescription dose of 42 Gy in 14 fractions and prophylactic proton pump inhibitor administration for 6 months. The oncological outcomes and toxicities were investigated. Results: A total of 66 patients with 73 lesions were eligible. The median follow-up period was 24.0 months. The local recurrence, intrahepatic recurrence, liver-related death, and overall survival rates at 2 years were 11.3%, 50.6%, 15.9%, and 60.4%, respectively. Six (9.1%) patients experienced Child–Pugh score deterioration ≥2 within 6 months following treatment. Two and one patient developed grades 2 and 3 gastroduodenal bleeding, respectively. Conclusions: HFRT can achieve good local control in patients with HCC adjacent to the GI tract, with low GI toxicity incidence. Our study demonstrated that HFRT can be a potentially curative treatment option for lesions.

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The Japanese Breast Cancer Society Clinical Practice Guideline for radiation treatment of breast cancer, 2018 edition

Breast Cancer 2020.01

ISSN 1340-6868

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Purpose</jats:title>
<jats:p>The Japanese Breast Cancer Society (JBCS) Clinical Practice Guideline was revised in 2018. This article describes the revise points in the section on radiation therapy (RT).</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods and materials</jats:title>
<jats:p>The JBCS formed task force to update the JBCS Clinical Practice Guideline 2015 edition. Background questions (BQs) deal with standard treatments of breast cancer in clinical practice. Clinical questions (CQs) highlight the important treatments in which controversy remains. The task force for RT section addressed the 10 BQs, the 10 CQs, and the 4 Future reseach questions (FQs). For each CQ, systematic literature reviews and meta-analyses were conducted, and recommendations, strength of recommendation and strength of evidence were determined according to the protocol in Morizane et al. (Minds Handbook for Clinical Practice Guideline Development, 2014).</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>The recommendations, the strength of recommendation and the strength of evidence were determined based on the systematic literature reviews and the meta-analyses for each CQ.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>The JBCS updated the Clinical Practice Guideline. RT represents a significant portion of the breast cancer treatment, and these recommendations regarding RT will be useful in individualized, shared decision making between physicians and patients.</jats:p>
</jats:sec>

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