Adapting radiation therapy to immunotherapy: Delineation and treatment planning of pre-operative immune-modulating breast iSBRT in 151 patients treated in the randomized phase II Neo-CheckRay trial.

De Caluwé, A;Bellal, S;Cao, K;Peignaux, K;Poortmans, P;et.al.
(2025) Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology — Vol. 206, p. 110836 (2025)

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Authors
  • De Caluwé, A
    Author
  • Bellal, S
    Author
  • Cao, K
    Author
  • Peignaux, K
    Author
  • Remouchamps, Vincentorcid-logoUCLouvain
    Author
  • Longton, EléonoreUCLouvain
    Author
  • Poortmans, P
    Author
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Abstract
The randomized multicentric phase II Neo-CheckRay trial investigated preoperative immune-modulating stereotactic body radiation therapy (iSBRT) 8 Gy x 3 fractions in combination with chemotherapy with or without the anti PD-L1 durvalumab and the anti-CD73 oleclumab in early-stage, high-risk, luminal B breast cancer. iSBRT was solely delivered to the primary breast cancer leveraging on its immune modulating potential to sustain an anti-tumour response. To avoid immunosuppression induced by radiation therapy (RT), the tumour draining lymph nodes (TDLN) were spared. Here, we present the constraints used in the Neo-CheckRay trial and a dosimetric analysis of all delivered treatment plans with a special focus on the dose to the TDLN. Main constraints were the skin (D0.1 cc < 19.2 Gy), chest wall (D1cc < 15 Gy) and ipsilateral uninvolved breast (V24Gy < 30 %). The dose to the TDLN was reduced by avoiding beams entering or exiting the TDLN. In the present work, the DICOM-RT data of all the patients treated in the Neo-CheckRay trial were collected (n = 151) to describe doses to the target volume, to the organs at risk and the TDLN. The TDLN volumes consisted of the internal mammary nodes (IMN) and the axilla levels I-IV including the interpectoral nodes. In 151 patients, the median V95% of the gross target volume (GTV) and planning target volume (PTV) were 97.4 % (90 % CI 26.5-100) and 95.5 % (56.1-100). The mean dose (dMean) to all TDLN volumes was < 1 Gy. The highest dMean were to the IMN and axilla level 1: 0.8 Gy (90 % CI 0.1-2.7) and 0.6 Gy (0.0-3.9), respectively. The dMean to the involved lymph nodes, if present, was 0.3 Gy (0.0-5.0). In the Neo-CheckRay trial, the predefined organs at risk dose constraints were feasible and the TDLN were adequately spared.
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De Caluwé, A., Bellal, S., Cao, K., Peignaux, K., Remouchamps, V., Baten, A., Longton, E., Bessieres, I., Vu-Bezin, J., Kirova, Y., Gestel, D. V., Desmoulins, I., Ignatiadis, M., Romano, E., Buisseret, L., Piccart, M., Vandekerkhove, C., Gulyban, A., & Poortmans, P. (2025). Adapting radiation therapy to immunotherapy: Delineation and treatment planning of pre-operative immune-modulating breast iSBRT in 151 patients treated in the randomized phase II Neo-CheckRay trial. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 206, 110836. https://doi.org/10.1016/j.radonc.2025.110836 (Original work published 2025)