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Shukla U, Langner UW, Linshaw D, Tan S, Huber KE, Miller CJ, Yu E, Leonard KL, Sueyoshi M, Diamond B, Edmonson D, Wazer DE, Gass J, Hepel JT. Comparison of Tumor Bed Delineation Using a Novel Radiopaque Filament Marker Versus Surgical Clips for Targeting Breast Cancer Radiotherapy. Am J Clin Oncol 2023; 46:427-432. [PMID: 37440682 DOI: 10.1097/coc.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Accuracy of tumor bed (TB) delineation is essential for targeting boost doses or partial breast irradiation. Multiple studies have shown high interobserver variability with standardly used surgical clip markers (CMs). We hypothesize that a radiopaque filament marker (FM) woven along the TB will improve TB delineation consistency. METHODS An FDA-approved FM was intraoperatively used to outline the TB of patients undergoing lumpectomy. Between January 2020 and January 2022, consecutive patients with FM placed after either (1) lumpectomy or (2) lumpectomy with oncoplastic reconstruction were identified and compared with those with CM. Six "experts" (radiation oncologists specializing in breast cancer) across 2 institutions independently defined all TBs. Three metrics (volume variance, dice coefficient, and center of mass [COM] deviation). Two-tailed paired samples t tests were performed to compare FM and CM cohorts. RESULTS Twenty-eight total patients were evaluated (14 FM and 14 CM). In aggregate, differences in volume between expert contours were 29.7% (SD ± 58.8%) with FM and 55.4% (SD ± 105.9%) with CM ( P < 0.001). The average dice coefficient in patients with FM was 0.54 (SD ± 0.15), and with CM was 0.44 (SD ± 0.22) ( P < 0.001). The average COM deviation was 0.63 cm (SD ± 0.53 cm) for FM and 1.05 cm (SD ± 0.93 cm) for CM; ( P < 0.001). In the subset of patients who underwent lumpectomy with oncoplastic reconstruction, the difference in average volume was 21.8% (SD ± 20.4%) with FM and 52.2% (SD ± 64.5%) with CM ( P <0.001). The average dice coefficient was 0.53 (SD ± 0.12) for FM versus 0.39 (SD ± 0.24) for CM ( P < 0.001). The average COM difference was 0.53 cm (SD ± 0.29 cm) with FM versus 1.25 cm (SD ± 1.08 cm) with CM ( P < 0.001). CONCLUSION FM consistently outperformed CM in the setting of both standard lumpectomy and complex oncoplastic reconstruction. These data suggest the superiority of FM in TB delineation.
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Affiliation(s)
- Utkarsh Shukla
- Department of Radiation Oncology, Tufts University School of Medicine, Boston
- Department of Radiation Oncology, Lifespan Cancer Institute
- Warren Alpert Medical School of Brown University
| | - Ulrich W Langner
- Department of Radiation Oncology, Lifespan Cancer Institute
- Warren Alpert Medical School of Brown University
| | - David Linshaw
- Department of Surgical Oncology, University of Massachusetts School of Medicine, Worcester, MA
- Program in Women's Oncology, Women and Infants' Hospital, Providence, RI
| | - Sydney Tan
- Warren Alpert Medical School of Brown University
| | - Kathryn E Huber
- Department of Radiation Oncology, Tufts University School of Medicine, Boston
- Department of Radiation Oncology, Lifespan Cancer Institute
- Warren Alpert Medical School of Brown University
| | - Chelsea J Miller
- Department of Radiation Oncology, Tufts University School of Medicine, Boston
- Department of Radiation Oncology, Lifespan Cancer Institute
- Warren Alpert Medical School of Brown University
| | - Esther Yu
- Department of Radiation Oncology, Tufts University School of Medicine, Boston
- Department of Radiation Oncology, Lifespan Cancer Institute
- Warren Alpert Medical School of Brown University
| | - Kara L Leonard
- Department of Radiation Oncology, Tufts University School of Medicine, Boston
- Department of Radiation Oncology, Lifespan Cancer Institute
- Warren Alpert Medical School of Brown University
| | - Mark Sueyoshi
- Department of Radiation Oncology, Tufts University School of Medicine, Boston
- Department of Radiation Oncology, Lifespan Cancer Institute
- Warren Alpert Medical School of Brown University
| | - Brett Diamond
- Department of Radiation Oncology, Tufts University School of Medicine, Boston
- Department of Radiation Oncology, Lifespan Cancer Institute
- Warren Alpert Medical School of Brown University
| | - David Edmonson
- Warren Alpert Medical School of Brown University
- Program in Women's Oncology, Women and Infants' Hospital, Providence, RI
| | - David E Wazer
- Department of Radiation Oncology, Tufts University School of Medicine, Boston
- Department of Radiation Oncology, Lifespan Cancer Institute
- Warren Alpert Medical School of Brown University
| | - Jennifer Gass
- Warren Alpert Medical School of Brown University
- Program in Women's Oncology, Women and Infants' Hospital, Providence, RI
| | - Jaroslaw T Hepel
- Department of Radiation Oncology, Tufts University School of Medicine, Boston
- Department of Radiation Oncology, Lifespan Cancer Institute
- Warren Alpert Medical School of Brown University
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Special Techniques of Adjuvant Breast Carcinoma Radiotherapy. Cancers (Basel) 2022; 15:cancers15010298. [PMID: 36612294 PMCID: PMC9818986 DOI: 10.3390/cancers15010298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Modern radiotherapy techniques are designed to permit reduced irradiation of healthy tissue, resulting in a diminished risk of adverse effects and shortened recovery times. Several randomized studies have demonstrated the benefits of increased dosage to the tumor bed area in combination with whole breast irradiation (WBI). Conventional WBI treatment following breast-conserving procedures, which required 5-7 weeks of daily treatments, has been reduced to 3-4 weeks when using hyperfractionated regimens. The dosage administration improves local control, albeit with poorer cosmesis. The method of accelerated partial breast irradiation (APBI) shortens the treatment period whilst reducing the irradiated volume. APBI can be delivered using intraoperative radiation, brachytherapy, or external beam radiotherapy. Currently available data support the use of external beam partial breast irradiation in selected patients. Modern radiotherapy techniques make it possible to achieve favorable cosmesis in most patients undergoing immediate breast reconstruction surgery, and studies confirm that current methods of external beam radiation allow an acceptable coverage of target volumes both in the reconstructed breast and in the regional lymphatic nodes.
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Lowrey N, Koch CA, Purdie T, Simeonov A, Conroy L, Han K. Magnetic Resonance Imaging for Breast Tumor Bed Delineation: Computed Tomography Comparison and Sequence Variation. Adv Radiat Oncol 2021; 6:100727. [PMID: 34409213 PMCID: PMC8361056 DOI: 10.1016/j.adro.2021.100727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Our purpose was to investigate the interobserver variability in breast tumor bed delineation using magnetic resonance (MR) compared with computed tomography (CT) at baseline and to quantify the change in tumor bed volume between pretreatment and end-of-treatment MR for patients undergoing whole breast radiation therapy. Methods and Materials Forty-eight patients with breast cancer planned for whole breast radiation therapy underwent CT and MR (T1, T1 fat-suppression [T1fs], and T2) simulation in the supine treatment position before radiation therapy and MR (T1, T1fs, and T2) at the end of treatment in the same position. Two observers delineated 50 tumor beds on the CT and all MR sequences and assigned cavity visualization scores to the images. The primary endpoint was interobserver variability, measured using the conformity index (CI). Results The mean cavity visualization scores at baseline were 3.14 (CT), 3.26 (T1), 3.41 (T1fs), and 3.58 (T2). The mean CIs were 0.65, 0.65, 0.72, and 0.68, respectively. T1fs significantly improved interobserver variability compared with CT, T1, or T2 (P < .001, P < .001, and P = .011, respectively). The CI for T1fs was significantly higher than T1 and T2 at the end of treatment (mean 0.72, 0.64, and 0.66, respectively; P < .001). The mean tumor bed volume on the T1fs sequence decreased from 18 cm3 at baseline to 13 cm3 at the end of treatment (P < .01). Conclusions T1fs reduced interobserver variability on both pre- and end-of-treatment scans and measured a reduction in tumor bed volume during whole breast radiation therapy. This rapid sequence could be easily used for adaptive boost or partial breast irradiation, especially on MR linear accelerators.
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Affiliation(s)
- Nicola Lowrey
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Christine A Koch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Thomas Purdie
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Anna Simeonov
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Leigh Conroy
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Kathy Han
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
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Jin M, Liu X, Ma J, Sun X, Zhen H, Shen J, Liu Z, Lian X, Miao Z, Hu K, Hou X, Zhang F. The Impact of Different Simulation Modalities on Target Volume Delineation in Breast-Conserving Radiotherapy. Cancer Manag Res 2021; 13:5633-5640. [PMID: 34285583 PMCID: PMC8285125 DOI: 10.2147/cmar.s301705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose In the management of breast-conserving radiotherapy, computed tomography (CT) simulation is now commonly used to identify tumor bed while has difficulties defining precisely. We aimed to evaluate the impact of magnetic resonance (MR) and CT simulation on defining the postoperative tumor bed for breast-conserving radiotherapy in patients without the aid of surgical clips. Methods From August 2018 to March 2019, twenty patients with T1-2N0M0 breast cancer at our institution were enrolled. All the patients underwent breast-conserving surgery without implantation of surgical clips and were prepared to receive radiotherapy. CT and MR images were acquired on the same day for each patient. Three radiation oncologists independently assigned cavity visualization score (CVS) and delineated the tumor bed based on first the CT then the MR images. Interobserver variability was assessed by volumes, generalized conformity index (CIgen) and the distance between the centers of mass (dCOM). Differences in mean values for parameters were tested by paired t-test or one-way analysis of variance, as appropriate. Results First, the mean volumes of tumor bed derived from MR were 22%, 27% and 21% smaller than those based on CT images for each observer. In addition, the mean CIgen was significantly superior, and dCOM was smaller for MR than for CT images (CIgen: 0.59 vs 0.52, P= 0.008; dCOM: 1.30 cm vs 1.39 cm, P= 0.095). Moreover, the mean CVS was 3.23±1.34 and 2.43±0.92 for MR and CT images, respectively (P= 0.035). Last, a positive association was observed between the CVS and CIgen for both modalities (P< 0.01). Conclusion Compared to CT, MR can improve the visualization of changes in the postoperative tumor bed. In addition, MR can yield a more precise definition of the tumor bed and improve the consistency of tumor bed contouring in patients without surgical clips.
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Affiliation(s)
- Meng Jin
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Xia Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jiabin Ma
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiansong Sun
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hongnan Zhen
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Shen
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xin Lian
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zheng Miao
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Lee G, Tsui H, Koch CA, Fyles A. Are we missing the post-operative cavity in whole breast radiotherapy? J Med Imaging Radiat Sci 2021; 52:207-213. [PMID: 33926849 DOI: 10.1016/j.jmir.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND/PURPOSE Whole breast radiotherapy (RT) following breast-conserving surgery is a standard treatment option in early-stage breast cancer patients. The whole breast RT technique targets the entire breast, traditionally identified based on breast palpation and the lumpectomy scar. The aim of this study is to evaluate dosimetry of the tumour bed (cavity) and location of recurrence in women treated with breast radiotherapy without explicit cavity delineation. MATERIALS/METHODS 50 consecutive women previously treated with whole breast RT were retrospectively contoured to define the post-operative cavity with a 1.0 cm expansion for planning target volume (cPTV). The cavity and cPTV dosimetric coverage [volume receiving 92%(V92%) and 95%(V95%) prescription] were calculated. Cavity and cPTV location were classified as inside, at edge or outside of previous treatment fields and recurrence rates were collected. RESULTS Forty-five (90%) women had cavities located inside the previous treatment fields (CAVin) and 5 women (10%) had cavities located outside(4) or at edge(1) of previous fields (CAVout/edge). CAVout/edge were located in extreme aspects of the breast: lateral(3); medial(1); or superior(1). Mean cavity_V92% was 91.6% vs 98.5% for CAVout/edge vs CAVin (p = 0.042). Mean cPTV_V92% was 78.7% vs 97.2% for cPTVout/edge vs cPTVin (p<0.001). At 5-year follow-up, 20% (1/5) of the CAVout/edge had 1 in-breast recurrence near the cavity (at previous field edge). Within the CAVin cohort, 11 patients were lost to follow-up and 6% (2/34) patients had in-breast recurrence. CONCLUSIONS In patients treated with whole breast RT without cavity delineation, 10% did not have ideal dosimetric coverage of the cavity. Cavity delineation in treatment planning provides optimal tumour bed coverage for patients undergoing whole breast RT, and is of particular importance for the coverage of cavities located in the extreme margins of the breast.
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Affiliation(s)
- Grace Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - Hugh Tsui
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - C Anne Koch
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Fyles
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Aldosary G, Caudrelier JM, Arnaout A, Chang L, Tse T, Foottit C, Song J, Belec J, Vandervoort E. Can we rely on surgical clips placed during oncoplastic breast surgery to accurately delineate the tumor bed for targeted breast radiotherapy? Breast Cancer Res Treat 2021; 186:343-352. [PMID: 33484375 DOI: 10.1007/s10549-020-06086-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Oncoplastic breast surgery (OBS) is gaining popularity among surgeons for breast-conserving surgery treatments. OBS relies on complex relocation and deformation of breast tissue involving the tumor bed (TB). In this study, we investigate the validity of using surgical clips with OBS for accurate TB delineation in adjuvant, targeted breast radiotherapy. METHODS Different OBS techniques were simulated on realistic breast phantoms. Surgical clips were used to demarcate the TB. Following tumor resection and closure, the true TB (TBTrue) was extracted. Each phantom was CT imaged at several phases of surgery in order to record pre- and post-OBS closure surgical clip displacements. Two senior radiation oncologists (ROs) were asked to delineate TBs on CTs by relying on surgical clips placed as per standard protocol, and by referring to operative notes. Their original contours, as well as those expanded using 5-15 mm margins, were compared with the accurate TBTrue using the dice similarity coefficient (DSC), Hausdorff Distance (HD), and over- and under-contoured volumes. Inter- and intra-RO contour agreements were also evaluated. RESULTS Post-OBS surgical clips were significantly displaced outside the original breast quadrant. Inter- and Intra-RO TB contours were consistent, yet systematically differed from TBTrue (DSC values range = 0.38 to 0.69, and maximum HD range = 17.8 mm to 38.0 mm). Using expansion margins did not improve contour congruence and caused significant over-contoured volumes. CONCLUSION Following OBS, surgical clips alone are not reliable radiographic surrogates of TB locations and accurate TB delineation is challenging. For complex OBS cases, indication of any type of partial breast irradiation is very questionable.
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Affiliation(s)
- Ghada Aldosary
- Department of Physics, Carleton University, Ottawa, ON, Canada. .,Radiation Oncology Section, Department of Oncology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Jean-Michel Caudrelier
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Angel Arnaout
- Department of Surgery, The University of Ottawa, Ottawa, ON, Canada.,Department of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Lynn Chang
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tabitha Tse
- Department of Surgery, The University of Ottawa, Ottawa, ON, Canada
| | - Claire Foottit
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Jiheon Song
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Jason Belec
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Eric Vandervoort
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
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Comparison of postoperative CT- and preoperative MRI-based breast tumor bed contours in prone position for radiotherapy after breast-conserving surgery. Eur Radiol 2020; 31:345-355. [PMID: 32740818 PMCID: PMC7755637 DOI: 10.1007/s00330-020-07085-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 07/20/2020] [Indexed: 02/05/2023]
Abstract
Objectives To compare the target volume of tumor bed defined by postoperative computed tomography (post-CT) in prone position registered with or without preoperative magnetic resonance imaging (pre-MRI). Methods A total of 22 patients were included with early-stage breast invasive ductal cancer, who have undergone breast-conservative surgery and received the pre-MRI and post-CT in prone position. The MRI sequences (T1W, T2W, T2W-SPAIR, DWI, dyn-eTHRIVE, sdyn-eTHRIVE) were delineated and manually registered to CT, respectively. The clinical target volumes (CTVs) and planning target volumes (PTVs) were contoured on CT and different MRI sequences, respectively. Differences were measured in terms of consistence index (CI), dice coefficient (DC), geographical miss index (GMI), and normal tissue index (NTI). Results The differences of delineation volumes among CT and MRIs were significant, both in the CTVs (p = 0.035) and PTVs (p < 0.001). The values of CI and DC for sdyn-eTHRIVE registration to CT were the largest among all MRI sequences, but GMI and NTI were the smallest. No obvious linear correlation (p > 0.05) between the CI derived from the registration of CT and sdyn-eTHRIVE of CTV with the breast volume, the cavity visualization score (CVS) of CT, time interval from surgery to CT simulation, the maximum diameter of the intraoperative mass, and the number of titanium clips, respectively. Conclusions The CTVs and PTVs in MRI sequences were all smaller than those in CT. The pre-MRI, especially the sdyn-eTHRIVE, could be used to optimize the post-CT-based target delineation of breast cancer. Key Points • Registered pre-MRI to post-CT in order to improve the accuracy of target volume delineation of breast cancer. • The CTVs and PTVs in MRI sequences were all smaller than those in CT. • The sdyn-eTHRIVE of pre-MRIs may be a better choice to improve the delineation of CT-based CTV and PTV. Electronic supplementary material The online version of this article (10.1007/s00330-020-07085-0) contains supplementary material, which is available to authorized users.
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Recht A. Whole-Breast Irradiation Is the Preferred Standard of Care for the Majority of Patients With Early-Stage Breast Cancer. J Clin Oncol 2020; 38:2263-2267. [PMID: 32442072 DOI: 10.1200/jco.19.02388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Abram Recht
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Serban M, Lambert C, Ruo R, Maietta C, Parker W, Evans M, Hijal T. Computed tomography-based virtual simulation versus ultrasound-based clinical setup in electron breast boost radiotherapy: Methodology for CT-based electron virtual simulation. Phys Med 2019; 67:100-106. [PMID: 31704390 DOI: 10.1016/j.ejmp.2019.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/06/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To compare clinical setup using ultrasound (U/S)-delineated target versus computed tomography (CT) virtual simulation using CT-outlined target in breast electron boost. To describe a methodology for electron virtual simulation and collision testing with the treatment planning system (TPS). METHODS The two techniques were compared in a prospective study on 12 patients, who were treated using a clinical setup. Target definition was performed by both U/S and CT imaging. The U/S-based target was made visible on CT images by placing a radio-opaque wire on U/S skin markings. The dose distribution of the clinical setup was reproduced in the TPS using the actual electron patient treatment parameters. A CT-based TPS virtual simulation/dose optimization was compared to the clinical setup technique. RESULTS Mean beam aperture was larger by 16.3 cm2 (p = 0.011) for U/S compared to CT-outlined target. Target mean depth difference (CT minus U/S) was 0.03 cm (p = 0.875). Target coverage at depth was adequate in all cases with CT-based simulation while under/overcovering the target at depth by more than 5 mm in 2 out of 12 cases with clinical setup. Mean target V90% was 98.5% (CT-based simulation) and 84.4% (clinical setup). Ipsilateral lung/breast were better spared with CT-based simulation. To date, the methodology for CT virtual simulation was applied on 152 patients and collision was avoided in all cases. CONCLUSIONS CT-based simulation and target delineation allows for improved definition of the en-face electron field with less amount of normal tissue irradiated while including the entire target with an adequate margin and optimal electron energy.
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Affiliation(s)
- Monica Serban
- Department of Medical Physics, Cedars Cancer Centre, McGill University Health Centre, Glen Campus, 1001 Décarie Boul., Montreal H4A 3J1, Canada.
| | - Christine Lambert
- Department of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, Glen Campus, 1001 Décarie Boul., Montreal H4A 3J1, Canada
| | - Russell Ruo
- Department of Medical Physics, Cedars Cancer Centre, McGill University Health Centre, Glen Campus, 1001 Décarie Boul., Montreal H4A 3J1, Canada
| | - Ciro Maietta
- Department of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, Glen Campus, 1001 Décarie Boul., Montreal H4A 3J1, Canada
| | - William Parker
- Department of Medical Physics, Cedars Cancer Centre, McGill University Health Centre, Glen Campus, 1001 Décarie Boul., Montreal H4A 3J1, Canada
| | - Michael Evans
- Department of Medical Physics, Cedars Cancer Centre, McGill University Health Centre, Glen Campus, 1001 Décarie Boul., Montreal H4A 3J1, Canada
| | - Tarek Hijal
- Department of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, Glen Campus, 1001 Décarie Boul., Montreal H4A 3J1, Canada
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Jung W, Kim K, Paik NS. Displacement of Surgical Clips in Patients with Human Acellular Dermal Matrix in the Excision Cavity during Whole Breast Irradiation Following Breast-Conserving Surgery. Cancer Res Treat 2019; 52:388-395. [PMID: 31476850 PMCID: PMC7176972 DOI: 10.4143/crt.2019.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/12/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the displacement of surgical clips in the excision cavity during whole breast irradiation following breast-conserving surgery (BCS) with or without acellular dermal matrix (ADM) insertion, and to analyze clinicopathologic factors associated with the displacement of surgical clips. MATERIALS AND METHODS From 2016 to 2017, 100 consecutive breast cancer patients who underwent BCS with the placement of surgical clips (superior, inferior, medial, lateral, and deep sides) in the tumor bed were included in this study. All patients took first planning computed tomography (CT) scan (CT 1) before whole breast irradiation and second CT scan (CT 2) before boost irradiation. Between two sets of planning CT, the displacement of surgical clips was calculated from the ΔX (lateral-medial), ΔY (anterior-posterior), ΔZ (superior-inferior), and three-dimensional (3D) directions. Patients were divided into two groups according to the breast volume replacement with ADM: group A with ADM and group B without ADM. RESULTS The means and 1 standard deviations of 3D displacement for superior, inferior, medial, lateral and deep clips were 5.2±2.9, 5.2±3.2, 5.6±4.5, 5.6±4.3, and 4.9±4.9 mm in entire cohort (n=100); 5.6±2.6, 6.0±3.5, 6.7±5.8, 6.7±5.7, and 6.1±7.4 mm in group A (n=38); 4.9±3.1, 4.8±3.0, 5.0±3.5, 5.0±2.9, and 4.3±2.8 mm in group B (n=62), respectively. The 3D displacements of group A were longer than those of group B, but only significant difference was observed in lateral clip (p=0.047). CONCLUSION This study demonstrated displacement of surgical clips during whole breast irradiation in patients with ADM insertion. For patients who had breast volume replacement using ADM, adaptive boost planning should be considered.
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Affiliation(s)
- Wonguen Jung
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Nam Sun Paik
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
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Abstract
In New Zealand, oncoplastic surgery is common, but partial breast reconstruction presents challenges for radiation therapy targeting. Tissue rearrangement creates ambiguity when targeting the tumor bed, with resultant overestimation of treatment volumes. Thus, adoption of advanced methods of radiation therapy have been hindered. This pilot study describes use of a novel three-dimensional implant that provides a scaffolding for tissue ingrowth during partial breast reconstruction and delineates the tumor bed more precisely to assist radiation planning and mammographic surveillance. After informed consent, 15 women were implanted with the three-dimensional bioabsorbable implant. The device was sutured to the tumor bed during lumpectomy, and tissue flaps were mobilized and attached to the implant. Visualization of the marker and radiation treatment volumes were recorded and compared. The implant provided volume replacement and helped to maintain breast contour. Cosmetic outcomes were excellent; no device- or radiation-related complications occurred. One patient had a postoperative hematoma that resolved after percutaneous drainage; there were no postoperative infections. Three-year follow-up shows no tumor recurrences and no untoward effects. When compared to conventional radiation targeting, use of the implant showed that a greater than 50 percent reduction in treatment volume was possible in some cases. Three-year mammograms show no significant artifact, normal tissue ingrowth, and minimal fibrosis. This study describes a method of oncoplastic breast reconstruction using an implantable device that marks the site of tumor excision and provides for volume replacement with tissue ingrowth. Patients tolerated it well, and radiation therapy planning, positioning, and treatment were facilitated.
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Shioji M, Nakata M, Fujimoto T, Nakamura M, Ishihara Y. [Comparison of Monitor Unit between Electron Monte Carlo Algorithm by Different Dose Normalization Methods and Conventional Manual Calculation]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:755-764. [PMID: 31434847 DOI: 10.6009/jjrt.2019_jsrt_75.8.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to evaluate the discrepancy between the monitor unit (MU) calculated by different dose normalization methods in the electron Monte Carlo (eMC) algorithm and the conventional manual MU. In the water phantom condition, the manual MU obtained from the measured output factor was compared with the calculated MU by the eMC algorithm, using 24 different irradiation field shapes and several different energies of electron beam. In the breast boost condition, calculated MUs by both calculation methods were evaluated for 45 cases. As a result, the MUs computed by the eMC algorithm in the water phantom varied according to the dose normalization methods, and the mean±standard deviation of the difference between the manual and calculated MU were 1.1±1.4%, 0.0±1.0% and 0.4±1.2% in peak depth normalization (PN), no plan normalization (NPN) and 100% at body maximum (100%BM), respectively. In breast-boost cases, the MU difference between the manual and the calculated MU were 6.1±3.7%, 3.4±2.8% and 1.1±2.9% in PN, NPN and 100%BM, respectively. We revealed that the resultant MU calculated by eMC algorithm was dependent on the dose normalization method and the averaged differences exceeded 6% in PN, especially in breast boost condition. When using the eMC in the breast boost condition, it is desirable to select an appropriate dose normalization method according to dose prescription policies at each facility.
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Affiliation(s)
- Maki Shioji
- Division of Clinical Radiology Service, Kyoto University Hospital
| | - Manabu Nakata
- Division of Clinical Radiology Service, Kyoto University Hospital
| | | | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University
| | - Yoshitomo Ishihara
- Division of Medical Physics, Department of Radiation Oncology, Japanese Red Cross Wakayama Medical Center
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de Freitas TB, Lopes de Barros Lima KM, de Andrade Carvalho H, de Azevedo Marques P, Belfort Mattos FT, Franco Fonseca AS, Munhoz AM, Filassi JR, Stuart SR, Marta GN. What a difference a clip makes! Analysis of boost volume definition in radiation therapy for conservative breast surgery. Eur J Surg Oncol 2018; 44:1312-1317. [PMID: 30041975 DOI: 10.1016/j.ejso.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/04/2018] [Accepted: 06/11/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE/OBJECTIVE(S) To evaluate the role of surgical clips placement in the definition of boost treatment volume. MATERIALS/METHODS Clinical Target Volumes (CTV) were defined as: CTV Breast, CTV Quadrant (based on physical exam and pre-surgical images), CTV Boost, defined by clip plus margin (1 cm for 2 or more clips and 2 cm for 1 clip only) plus radiological changes, CTV NT (normal tissue), defined by CTV Quadrant minus CTV Boost and CTV MISS (CTV that would be outside the treatment volume), defined by CTV Boost minus CTV Quadrant. RESULTS A total of 247 patients were included. Upper lateral quadrant was the most common clinical location (47.3%). The median number of clips used was three. The mean volumes were: CTV Breast:982.52 cc, CTV Boost:36.59 cc, CTV Quadrant:285.07 cc, CTV NT:210.1 cc and CTV MISS:13.57 cc. Only 50.6% (125) of the patients presented the CTV Boost completely inside the CTV Quadrant and in 47.3% (117), partially inside. Among patients with any CTV MISS, 80.3% (98) had 10% or more of CTV Boost outside the treatment volume. Regarding CTV MISS, there were no statistically significant differences between the groups with 1 clip versus 2 or more clips, nor between patients with or without reconstructive surgery. In average, the CTV Boost was 87% smaller than the CTV Quadrant. The whole quadrant irradiation would lead to unnecessary irradiation of 26% of normal breast tissue. CONCLUSION Surgical bed clipping is up most important in the definition of the boost volume irradiation to ensure precision minimizing geographical miss and optimizing surrounding normal tissue sparing.
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Affiliation(s)
- Thiago Brasileiro de Freitas
- Department of Radiology and Oncology, Division of Radiation Oncology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
| | | | - Heloísa de Andrade Carvalho
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto de Radiologia (INRAD), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
| | - Patricia de Azevedo Marques
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Fabio Teixeira Belfort Mattos
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Alexandre Siqueira Franco Fonseca
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Alexandre Mendonça Munhoz
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, Brazil.
| | - José Roberto Filassi
- Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Silvia R Stuart
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto de Radiologia (INRAD), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Gustavo Nader Marta
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
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Impact of a Novel Bioabsorbable Implant on Radiation Treatment Planning for Breast Cancer. World J Surg 2017; 41:464-471. [PMID: 27709273 DOI: 10.1007/s00268-016-3711-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Techniques for accurately delineating the tumor bed after breast-conserving surgery (BCS) can be challenging. As a result, the accuracy, and efficiency of radiation treatment (RT) planning can be negatively impacted. Surgically placed clips or the post-surgical seroma are commonly used to determine target volume; however, these methods can lead to a high degree of uncertainty and variability. A novel 3-dimensional bioabsorbable marker was used during BCS and assessed for its impact on RT planning. METHODS One hundred and ten implants were sutured to the margins of the tumor bed excision site in 108 patients undergoing BCS. Routine CT imaging of the breast tissue was performed for RT planning, and the marker was assessed for visibility and utility in target delineation. RT regimens, target volumes and associated treatment costs were analyzed. RESULTS In all patients, the marker was easily visible and in 95.7 % of cases, it proved useful for RT planning. 36.8 % of patients received conventional whole breast irradiation plus boost, 56.6 % received hypo-fractionation plus boost, and 6.6 % received accelerated partial breast irradiation. A shift toward increased use of hypo-fractionated regimens was noted over the three year period of this study. There were no device-related complications or cancer recurrences in this group of patients. CONCLUSIONS This study demonstrated the use of a novel 3-dimensional marker as a safe and effective method for delineating the tumor bed with a significant utility for RT planning. With routine use of the device, an increased use of hypofractionation with a resultant 25 % cost savings was noted.
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Updated feasibility and reproducibility results of multi-institutional study of noninvasive breast tumor bed boost. Brachytherapy 2016; 15:804-811. [DOI: 10.1016/j.brachy.2016.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 08/24/2016] [Accepted: 09/06/2016] [Indexed: 11/20/2022]
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De Santis MC, Nardone L, Diletto B, Canna R, Dispinzieri M, Marino L, Lozza L, Valentini V. Comparison of two radiation techniques for the breast boost in patients undergoing neoadjuvant treatment for breast cancer. Br J Radiol 2016; 89:20160264. [PMID: 27452265 DOI: 10.1259/bjr.20160264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE After breast conservative surgery (BCS) and whole-breast radiotherapy (WBRT), the use of boost irradiation is recommended especially in patients at high risk. However, the standard technique and the definition of the boost volume have not been well defined. METHODS We retrospectively compared an anticipated pre-operative photon boost on the tumour, administered with low-dose fractionated radiotherapy, and neoadjuvant chemotherapy with two different sequential boost techniques, administered after BCS and standard adjuvant WBRT: (1) a standard photon beam (2) and an electron beam technique on the tumour bed of the same patients. The plans were analyzed for the dosimetric coverage of the CT-delineated irradiated volume. The minimal dose received by 95% of the target volume (D95), the minimal dose received by 90% of the target volume (D90) and geographic misses were evaluated. RESULTS 15 patients were evaluated. The sequential photon and electron boost techniques resulted in inferior target volume coverage compared with the anticipated boost technique, with a median D95 of 96.3% (range 94.7-99.6%) and 0.8% (range 0-30%) and a median D90 of 99.1% (range 90.2-100%) and 54.7% (range 0-84.8%), respectively. We observed a geographic miss in 26.6% of sequential electron plans. The results of the anticipated boost technique were better: 99.4% (range 96.5-100%) and 97.1% (range 86.2-99%) for median D90 and median D95, respectively, and no geographic miss was observed. We observed a dose reduction to the heart, with left-sided breast irradiation, using the anticipated pre-operative boost technique, when analyzed for all dose-volume parameters. When compared with the sequential electron plans, the pre-operative photon technique showed a higher median ipsilateral lung Dmax. CONCLUSION Our data show that an anticipated pre-operative photon boost results in a better coverage with respect to the standard sequential boost while also saving the organs at risk and consequently fewer side effects. ADVANCES IN KNOWLEDGE This is the first dosimetric study that evaluated the association between an anticipated boost and neoadjuvant chemotherapy treatment.
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Affiliation(s)
- Maria C De Santis
- 1 Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigia Nardone
- 2 Department of Radiation Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Barbara Diletto
- 1 Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Canna
- 2 Department of Radiation Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Michela Dispinzieri
- 1 Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenza Marino
- 3 Division of Radiotherapy, REM-Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Laura Lozza
- 1 Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Vincenzo Valentini
- 2 Department of Radiation Oncology, Catholic University of the Sacred Heart, Rome, Italy
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Lewis L, Cox J, Morgia M, Atyeo J, Lamoury G. A clip-based protocol for breast boost radiotherapy provides clear target visualisation and demonstrates significant volume reduction over time. J Med Radiat Sci 2015; 62:177-83. [PMID: 26451239 PMCID: PMC4592671 DOI: 10.1002/jmrs.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/01/2015] [Accepted: 04/21/2015] [Indexed: 12/27/2022] Open
Abstract
Introduction The clinical target volume (CTV) for early stage breast cancer is difficult to clearly identify on planning computed tomography (CT) scans. Surgical clips inserted around the tumour bed should help to identify the CTV, particularly if the seroma has been reabsorbed, and enable tracking of CTV changes over time. Methods A surgical clip-based CTV delineation protocol was introduced. CTV visibility and its post-operative shrinkage pattern were assessed. The subjects were 27 early stage breast cancer patients receiving post-operative radiotherapy alone and 15 receiving post-operative chemotherapy followed by radiotherapy. The radiotherapy alone (RT/alone) group received a CT scan at median 25 days post-operatively (CT1rt) and another at 40 Gy, median 68 days (CT2rt). The chemotherapy/RT group (chemo/RT) received a CT scan at median 18 days post-operatively (CT1ch), a planning CT scan at median 126 days (CT2ch), and another at 40 Gy (CT3ch). Results There was no significant difference (P = 0.08) between the initial mean CTV for each cohort. The RT/alone cohort showed significant CTV volume reduction of 38.4% (P = 0.01) at 40 Gy. The Chemo/RT cohort had significantly reduced volumes between CT1ch: median 54 cm3 (4–118) and CT2ch: median 16 cm3, (2–99), (P = 0.01), but no significant volume reduction thereafter. Conclusion Surgical clips enable localisation of the post-surgical seroma for radiotherapy targeting. Most seroma shrinkage occurs early, enabling CT treatment planning to take place at 7 weeks, which is within the 9 weeks recommended to limit disease recurrence.
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Affiliation(s)
- Lorraine Lewis
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital Sydney, New South Wales, Australia
| | - Jennifer Cox
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital Sydney, New South Wales, Australia ; Faculty of Health Sciences, University of Sydney Sydney, New South Wales, Australia
| | - Marita Morgia
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital Sydney, New South Wales, Australia
| | - John Atyeo
- Faculty of Health Sciences, University of Sydney Sydney, New South Wales, Australia
| | - Gillian Lamoury
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital Sydney, New South Wales, Australia
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Patel H, Goyal S, Kim L. Using injectable hydrogel markers to assess resimulation for boost target volume definition in a patient undergoing whole-breast radiotherapy. Med Dosim 2015; 40:352-4. [PMID: 26051069 DOI: 10.1016/j.meddos.2015.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/16/2015] [Accepted: 04/27/2015] [Indexed: 11/27/2022]
Abstract
Several publications have recommended that patients undergoing whole-breast radiotherapy be resimulated for boost planning. The rationale for this is that the seroma may be smaller when compared with the initial simulation. However, the decision remains whether to use the earlier or later images to define an appropriate boost target volume. A patient undergoing whole-breast radiotherapy had new, injectable, temporary hydrogel fiducial markers placed 1 to 3cm from the seroma at the time of initial simulation. The patient was resimulated 4.5 weeks later for conformal photon boost planning. Computed tomography (CT) scans acquired at the beginning and the end of whole-breast radiotherapy showed that shrinkage of the lumpectomy cavity was not matched by a corresponding reduction in the surrounding tissue volume, as demarcated by hydrogel markers. This observation called into question the usual interpretation of cavity shrinkage for boost target definition. For this patient, it was decided to define the boost target volume on the initial planning CT instead of the new CT.
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Affiliation(s)
- Henal Patel
- Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, Piscataway, NJ
| | - Sharad Goyal
- Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, NJ
| | - Leonard Kim
- Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, NJ.
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Smith S, Comins C. Radiographer-led breast boost localisation – A service evaluation study. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Davidson S, Kirsner S, Mason B, Kisling K, Barrett RD, Bonetati A, Ballo MT. Dosimetric impact of setup accuracy for an electron breast boost technique. Pract Radiat Oncol 2015; 5:e499-e504. [PMID: 25858772 DOI: 10.1016/j.prro.2015.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/29/2015] [Accepted: 02/21/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine the setup error on an electron breast boost technique using daily cone beam computed tomography (CBCT). Patient and setup attributes were studied as contributing factors to the accuracy. METHODS AND MATERIALS Reproducibility of a modified lateral decubitus position breast boost setup was verified for 33 patients using CBCT. Three-dimensional matching was performed between the CBCT and the initial planning CT for each boost fraction by matching the tumor bed and/or surgical clips. The dosimetric impact of the daily positioning error was achieved by rerunning the initial treatment plans incorporating the recorded shifts to study the dose differences. Breast compression, decubitus angle, tumor bed location and volume, and cup size were studied for their contribution to setup error. RESULTS The range of setup errors was: 1.5 cm anterior to 9 mm posterior, 1.3 cm superior to 2.3 cm inferior, and 3.2 cm medial to 2.4 cm lateral. Seven patients had setup errors that were ≥2-cm margin placed on the tumor bed and scar. Four of those 7 patients had unacceptable coverage as defined by the volume of the tumor bed plus scar that is covered by the 90% isodose line (V90) compared with the original plan. All other patients had no discernible difference in the coverage (V90). The use of compression, tumor bed location, or volumes >20 mL showed no effect on coverage. CONCLUSIONS In general, this study supported that a 2-cm margin was adequate (29 of 33 patients) when patients are treated under typical conditions. Care should be taken when high electron energies are selected because the coverage at depth is more difficult to maintain in the clinical environment.
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Affiliation(s)
- Scott Davidson
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, Texas.
| | - Steven Kirsner
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Bryan Mason
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Kelly Kisling
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Renee D Barrett
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Anthony Bonetati
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Matthew T Ballo
- Department of Radiation Oncology, The University of Tennessee Health Science Center, Memphis, Tennessee
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Factors influencing eligibility for breast boost using noninvasive image-guided breast brachytherapy. Brachytherapy 2014; 13:579-83. [DOI: 10.1016/j.brachy.2014.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 11/21/2022]
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Chen X, Qiao Q, DeVries A, Li W, Currey A, Kelly T, Bergom C, Wilson JF, Li XA. Adaptive replanning to account for lumpectomy cavity change in sequential boost after whole-breast irradiation. Int J Radiat Oncol Biol Phys 2014; 90:1208-15. [PMID: 25442046 DOI: 10.1016/j.ijrobp.2014.08.342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/16/2014] [Accepted: 08/25/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the efficiency of standard image-guided radiation therapy (IGRT) to account for lumpectomy cavity (LC) variation during whole-breast irradiation (WBI) and propose an adaptive strategy to improve dosimetry if IGRT fails to address the interfraction LC variations. METHODS AND MATERIALS Daily diagnostic-quality CT data acquired during IGRT in the boost stage using an in-room CT for 19 breast cancer patients treated with sequential boost after WBI in the prone position were retrospectively analyzed. Contours of the LC, treated breast, ipsilateral lung, and heart were generated by populating contours from planning CTs to boost fraction CTs using an auto-segmentation tool with manual editing. Three plans were generated on each fraction CT: (1) a repositioning plan by applying the original boost plan with the shift determined by IGRT; (2) an adaptive plan by modifying the original plan according to a fraction CT; and (3) a reoptimization plan by a full-scale optimization. RESULTS Significant variations were observed in LC. The change in LC volume at the first boost fraction ranged from a 70% decrease to a 50% increase of that on the planning CT. The adaptive and reoptimization plans were comparable. Compared with the repositioning plans, the adaptive plans led to an improvement in target coverage for an increased LC case (1 of 19, 7.5% increase in planning target volume evaluation volume V95%), and breast tissue sparing for an LC decrease larger than 35% (3 of 19, 7.5% decrease in breast evaluation volume V50%; P=.008). CONCLUSION Significant changes in LC shape and volume at the time of boost that deviate from the original plan for WBI with sequential boost can be addressed by adaptive replanning at the first boost fraction.
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Affiliation(s)
- Xiaojian Chen
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Qiao Qiao
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Radiotherapy, First Hospital of China Medical University, Shenyang, China
| | - Anthony DeVries
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wenhui Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Radiotherapy, Yunnan Tumor Hospital, Kunming, China
| | - Adam Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tracy Kelly
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carmen Bergom
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - J Frank Wilson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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[Partial breast irradiation]. Bull Cancer 2014; 101:52-5. [PMID: 24445657 DOI: 10.1684/bdc.2013.1869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Owing to breast cancer screening, breast cancer is more and more diagnosed at early stage. For those breast cancer women, breast conserving treatment (breast conserving surgery followed by whole breast irradiation) is commonly used since many years. New radiation modalities have been recently developed in early breast cancers particularly accelerated partial breast irradiation (APBI). Among all techniques of radiotherapy, 3D-conformal APBI and intraoperative radiotherapy (IORT) are the main modalities of radiotherapy used. The present review states on indications, treatment modalities and updated results of local control and side effects of partial breast irradiation.
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Kirwan CC, Al Sarakbi W, Loncaster J, Chan HY, Thompson AM, Wishart GC. Tumour bed clip localisation for targeted breast radiotherapy: compliance is proportional to trial-related research activity: tumour bed clip localisation in breast radiotherapy. Eur J Surg Oncol 2013; 40:158-62. [PMID: 24373297 DOI: 10.1016/j.ejso.2013.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/24/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND In breast cancer, with the increasing use of intensity-modulated radiotherapy (IMRT), the need for accurate tumour bed localisation is paramount. We determined current practice of clip usage in patients referred to a regional centre for radiotherapy following breast conserving surgery. We also investigated whether participation of surgical units in IMRT trials, where tumour bed clip use is emphasised, was associated with clip insertion. METHODS A retrospective cohort study of consecutive CT planning images (n = 205), of breast cancer patients treated with radiotherapy following breast conserving surgery. Presence and number of clips; referring hospital and referring surgeon of the patient was recorded. This was correlated to previous participation of referring hospital to IMRT trials. RESULTS Of 196 eligible patients, 126 (64%) had clips sited, of which 15 (12%) had two or fewer clips. Five referring hospitals were high recruiters (≥14 patients), and five hospitals were low/non-recruiters (≤1 patient) to IMRT trials. Of patients from low/non-recruiting centres, 29 of 43 (67%) had clips omitted, compared to 41 of 153 (27%) from high-recruiting centres (p < 0.001). Median number of clips used in centres recruiting high numbers of patients was four, compared to zero in low recruiting centres. Ten of 31 referring surgeons routinely omitted clips. CONCLUSION Despite inclusion in national guidelines, clip insertion has not become routine in the UK in patients undergoing breast conserving surgery. However, hospitals involved in breast radiotherapy randomised controlled trials are more compliant with clip usage recommendations. Auditing of clip insertion should be considered as a quality control marker in breast surgery.
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Affiliation(s)
- C C Kirwan
- University of Manchester Department of Academic Surgery, South Manchester University Hospitals Trust, Southmoor Road, Manchester M23 9LT, UK.
| | - W Al Sarakbi
- Department of Surgery, Conquest Hospital, The Ridge, Hastings, East Sussex TN37 9RD, UK.
| | - J Loncaster
- Department of Clinical Oncology, Christie Hospital, Manchester M20 4BX, UK.
| | - H Y Chan
- Department of Surgery, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK.
| | - A M Thompson
- Clinical Research Centre, Dundee Cancer Centre, University of Dundee, Dundee DD1 9SY, UK.
| | - G C Wishart
- Faculty of Health, Social Care & Education, Anglia Ruskin University, East Road, Cambridge BB1 1PT, UK.
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Leonard KL, Hepel JT, Styczynski JR, Hiatt JR, DiPetrillo TA, Wazer DE. Breast Boost Using Noninvasive Image-Guided Breast Brachytherapy vs. External Beam: A 2:1 Matched-Pair Analysis. Clin Breast Cancer 2013; 13:455-9. [DOI: 10.1016/j.clbc.2013.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/02/2013] [Accepted: 08/26/2013] [Indexed: 11/28/2022]
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Truong MT, Hirsch AE, Kovalchuk N, Qureshi MM, Damato A, Schuller B, Vassilakis N, Stone M, Gierga D, Willins J, Kachnic LA. Cone-beam computed tomography image guided therapy to evaluate lumpectomy cavity variation before and during breast radiotherapy. J Appl Clin Med Phys 2013; 14:4243. [PMID: 23470944 PMCID: PMC5714375 DOI: 10.1120/jacmp.v14i2.4243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 11/21/2012] [Accepted: 11/30/2012] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to evaluate the rate of change (RoC) in the size of the lumpectomy cavity (LC) before and during breast radiotherapy (RT) using cone‐beam computed tomography (CBCT), relative to the initial LC volume at CT simulation (CTVLC) and timing from surgery. A prospective institutional review board‐approved study included 26 patients undergoing breast RT: 20 whole breast irradiation (WBI) patients and six partial breast irradiation (PBI) patients, with surgical clips outlining the LC. The patients underwent CT simulation (CTsim) followed by five CBCTs during RT, once daily for PBI and once weekly for WBI. The distance between surgical clips and their centroid (D) acted as a surrogate for LC size. The RoC of the LC size, defined as the percentage change of D between two scans divided by the time interval in days between the scans, was calculated before (CTsim to CBCT1) and during RT (CBCT1 to CBCT5). The mean RoC of D for all patients before starting RT was −0.25%/day (range, −1.3 to 1.4) and for WBI patients during RT was −0.15%/day (range, −0.45 to 0.40). Stratified by median CTVLC, the RoC before RT for large CTVLC group (≥25.7cc) was 15 times higher (−0.47%/day) than for small CTVLC group (<25.7 cc) (−0.03%/day), p=0.06. For patients undergoing CTsim< 42 days from surgery, the RoC before RT was −0.43%/day compared to −0.07%/day for patients undergoing CTsim≥42 days from surgery, p=0.12. For breast cancer RT, the rate of change of the LC is affected by the initial cavity size and the timing from surgery. Resimulation closer to the time of boost treatment should be considered in patients who are initially simulated within six weeks of surgery and/or with large CTVLC. PACS number: 87.55.de
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Affiliation(s)
- Minh Tam Truong
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA, USA.
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Chen SA, Schuster DM, Mister D, Liu T, Godette K, Torres MA. Radiation Field Design and Patterns of Locoregional Recurrence Following Definitive Radiotherapy for Breast Cancer. Int J Radiat Oncol Biol Phys 2013; 85:309-14. [DOI: 10.1016/j.ijrobp.2012.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/01/2012] [Accepted: 06/06/2012] [Indexed: 10/27/2022]
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Hansen CJ, de Winton E, Guglani S, Vamvakas E, Willis D, Chua BH. Target localisation for tumour bed radiotherapy in early breast cancer. J Med Imaging Radiat Oncol 2013; 56:452-7. [PMID: 22883655 DOI: 10.1111/j.1754-9485.2012.02380.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To compare clinical and CT techniques in localisation of the tumour bed in patients undergoing adjuvant breast radiotherapy for breast cancer. METHODS Patients were CT scanned in the treatment position following clinical delineation of the whole breast, surgical scar and boost volume. Computed tomography boost volumes were contoured in three dimensions. A definitive treatment plan was generated to encompass the CT-localised planning target volume (PTV) with ≥90% isodose using electrons. A hypothetical plan was also generated to cover the clinically determined boost field for comparison. The primary end point was the difference in PTV coverage by the 90% isodose between the plans based on clinically and CT localised boost volumes. RESULTS The plans for 50 patients were evaluated. The median percentage of PTV encompassed by the 90% isodose using the clinical and CT techniques was 29% (range 5-90%) and 83% (range 25-100%), respectively. PTV coverage by the 90% isodose using the clinical technique was at least 10% less than that using CT technique in 88% of patients (95% confidence interval 77-95%; P < 0.0001). CONCLUSION Tumour bed boost PTV coverage was insufficient using clinical determination as compared with CT localisation. This study supports CT planning for target volume localisation of the tumour bed boost in patients treated with breast-conserving therapy for breast cancer.
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Affiliation(s)
- Carmen J Hansen
- Department of Radiation Oncology Radiation Therapy Service, East Melbourne University of Melbourne, Melbourne, Victoria, Australia.
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Bourgier C, Aimard L, Bodez V, Bollet MA, Cutuli B, Franck D, Hennequin C, Kirova YM, Azria D. Adjuvant radiotherapy in the management of axillary node negative invasive breast cancer: a qualitative systematic review. Crit Rev Oncol Hematol 2012; 86:33-41. [PMID: 23088955 DOI: 10.1016/j.critrevonc.2012.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/06/2012] [Accepted: 09/25/2012] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To actualize and to detail guidelines used in technical radiotherapy and indications for innovative radiation technologies in early axillary node negative breast cancer (BC). METHODS Dosimetric and treatment planning studies, phase II and III trials, systematic reviews and retrospective studies were all searched (Medline(®) database). Their quality and clinical relevance were also checked against validated checklists. A level of evidence was associated for each result. RESULTS A total of 75 references were included. Adjuvant BC radiotherapy (50Gy/25 fractions/5 weeks followed by a tumor boost of 16Gy/8 fractions) is still the standard of care. Overall treatment time could be shortened for patients who present with low local relapse risk BC by using either hypofractionated whole breast irradiation; or accelerated partial breast irradiation. BC IMRT is not used in current practice. CONCLUSION Our group aimed to provide guidelines for technical and clinical applications of innovative BC radiation technologies.
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Affiliation(s)
- C Bourgier
- Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France.
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WANG WEI, FRENCH JAMES, BOYAGES JOHN. Put the felt pen away: Time to move on from a clinical mark-up for a breast boost. J Med Imaging Radiat Oncol 2012; 56:375-8. [DOI: 10.1111/j.1754-9485.2012.02402.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Acevedo-Henao CM, Heymann S, Rossier C, Garbay JR, Arnedos M, Balleyguier C, Ferchiou M, Marsiglia H, Bourgier C. [Conformal accelerated partial breast irradiation: state of the art]. Cancer Radiother 2012; 16:641-9. [PMID: 22727723 DOI: 10.1016/j.canrad.2012.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/09/2012] [Accepted: 03/27/2012] [Indexed: 11/26/2022]
Abstract
Breast conserving treatment (breast conserving surgery followed by whole breast irradiation) has commonly been used in early breast cancer since many years. New radiation modalities have been recently developed in early breast cancers, particularly accelerated partial breast irradiation. Three-dimensional conformal accelerated partial breast irradiation is the most commonly used modality of radiotherapy. Other techniques are currently being developed, such as intensity-modulated radiotherapy, arctherapy, and tomotherapy. The present article reviews the indications, treatment modalities and side effects of accelerated partial breast irradiation.
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Affiliation(s)
- C-M Acevedo-Henao
- Département de radiothérapie, institut de cancérologie Gustave-Roussy, Villejuif cedex, France
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Ten-year results of a phase II study with a single fraction of high-dose-rate brachytherapy (FAST-boost) after whole breast irradiation in invasive breast carcinoma. Clin Transl Oncol 2012; 14:109-15. [DOI: 10.1007/s12094-012-0769-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Njeh CF, Saunders MW, Langton CM. Accelerated partial breast irradiation using external beam conformal radiation therapy: A review. Crit Rev Oncol Hematol 2012; 81:1-20. [PMID: 21376625 DOI: 10.1016/j.critrevonc.2011.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 01/03/2011] [Accepted: 01/25/2011] [Indexed: 01/03/2023] Open
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Cho H, Kim C. Volumetric changes in the lumpectomy cavity during whole breast irradiation after breast conserving surgery. Radiat Oncol J 2011; 29:277-82. [PMID: 22984681 PMCID: PMC3429913 DOI: 10.3857/roj.2011.29.4.277] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 10/28/2011] [Accepted: 10/28/2011] [Indexed: 12/28/2022] Open
Abstract
Purpose This study was performed to evaluate the change in the lumpectomy cavity volumes before and after whole breast radiation therapy (WBRT) and to identify factors associated with the change of volume. Materials and Methods From September 2009 to April 2010, the computed tomography (CT) simulation data from 70 patients obtained before and after WBRT was evaluated. The lumpectomy cavity volumes were contoured based on surgical clips, seroma, and postoperative changes. Significant differences in the data from pre-WBRT CT and post-WBRT CT were assessed. Multiple variables were examined for correlation with volume reduction in the lumpectomy cavity. Results The mean and median volume reduction in the lumpectomy cavity after WBRT were 17.6 cm3 and 16.1 cm3, respectively with the statistical significance (p < 0.001). The volume reduction in the lumpectomy cavity was inversely correlated with time from surgery to radiation therapy (R = 0.390). The presence of seroma was significantly associated with a volumetric change in the lumpectomy cavity after WBRT (p = 0.011). Conclusion The volume of lumpectomy cavity reduced significantly after WBRT. As the time from surgery to the start of WBRT increased, the volume reduction in the lumpectomy cavity during WBRT decreased. A strong correlation was observed between the presence of seroma and the reduced volume. To ensure appropriate coverage and to limit normal tissue exposure during boost irradiation in patients who has seroma at the time of starting WBRT, repeating CT simulation at boost planning is suggested.
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Affiliation(s)
- Heunglae Cho
- Department of Radiation Oncology, Inje University College of Medicine, Busan, Korea
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El Nemr M, Heymann S, Verstraet R, Biron B, Azoury F, Marsiglia H, Bourgier C. Mixed modality treatment planning of accelerated partial breast irradiation: to improve complex dosimetry cases. Radiat Oncol 2011; 6:154. [PMID: 22074547 PMCID: PMC3262019 DOI: 10.1186/1748-717x-6-154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 11/10/2011] [Indexed: 12/25/2022] Open
Affiliation(s)
- Mohamed El Nemr
- Department of Radiation Oncology, Institut Gustave Roussy, 94805 Villejuif, France
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Yang Z, Chen J, Hu W, Pan Z, Cai G, Yu X, Mei X, Zhang Q, Liu T, Guo X. Planning the breast boost: How accurately do surgical clips represent the CT seroma? Radiother Oncol 2010; 97:530-4. [PMID: 20934763 DOI: 10.1016/j.radonc.2010.09.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 08/23/2010] [Accepted: 09/06/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Zhaozhi Yang
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Shanghai, China
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Impact of the radiation boost on outcomes after breast-conserving surgery and radiation. Int J Radiat Oncol Biol Phys 2010; 81:69-76. [PMID: 20732766 DOI: 10.1016/j.ijrobp.2010.04.067] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/19/2010] [Accepted: 04/23/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE We examined the impact of radiation tumor bed boost parameters in early-stage breast cancer on local control and cosmetic outcomes. METHODS AND MATERIALS A total of 3,186 women underwent postlumpectomy whole-breast radiation with a tumor bed boost for Tis to T2 breast cancer from 1970 to 2008. Boost parameters analyzed included size, energy, dose, and technique. Endpoints were local control, cosmesis, and fibrosis. The Kaplan-Meier method was used to estimate actuarial incidence, and a Cox proportional hazard model was used to determine independent predictors of outcomes on multivariate analysis (MVA). The median follow-up was 78 months (range, 1-305 months). RESULTS The crude cosmetic results were excellent in 54%, good in 41%, and fair/poor in 5% of patients. The 10-year estimate of an excellent cosmesis was 66%. On MVA, independent predictors for excellent cosmesis were use of electron boost, lower electron energy, adjuvant systemic therapy, and whole-breast IMRT. Fibrosis was reported in 8.4% of patients. The actuarial incidence of fibrosis was 11% at 5 years and 17% at 10 years. On MVA, independent predictors of fibrosis were larger cup size and higher boost energy. The 10-year actuarial local failure was 6.3%. There was no significant difference in local control by boost method, cut-out size, dose, or energy. CONCLUSIONS Likelihood of excellent cosmesis or fibrosis are associated with boost technique, electron energy, and cup size. However, because of high local control and rare incidence of fair/poor cosmesis with a boost, the anatomy of the patient and tumor cavity should ultimately determine the necessary boost parameters.
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Fraser DJ, Wong P, Sultanem K, Verhaegen F. Dosimetric evolution of the breast electron boost target using 3D ultrasound imaging. Radiother Oncol 2010; 96:185-91. [DOI: 10.1016/j.radonc.2010.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 05/18/2010] [Accepted: 05/31/2010] [Indexed: 11/29/2022]
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Strauss JB, Gielda BT, Chen SS, Shah AP, Abrams RA, Griem KL. Variation in Post-Surgical Lumpectomy Cavity Volume With Delay in Initiation of Breast Irradiation Because of Chemotherapy. Int J Radiat Oncol Biol Phys 2010; 77:831-5. [DOI: 10.1016/j.ijrobp.2009.05.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 05/28/2009] [Accepted: 05/29/2009] [Indexed: 11/16/2022]
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Kirova YM, Castro Pena P, Hijal T, Fournier-Bidoz N, Laki F, Sigal-Zafrani B, Dendale R, Bollet MA, Campana F, Fourquet A. Improving the definition of tumor bed boost with the use of surgical clips and image registration in breast cancer patients. Int J Radiat Oncol Biol Phys 2010; 78:1352-5. [PMID: 20381975 DOI: 10.1016/j.ijrobp.2009.10.049] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/10/2009] [Accepted: 10/13/2009] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the accuracy of a boost technique. METHODS AND MATERIALS Twenty-two patients underwent tumorectomy with placement of two or more clips in the surgical cavity before breast remodeling. Preoperative and postoperative computed tomography scans, with match-point registration, were performed on all patients. The relationship between the location of the gross tumor volume (GTV), defined on the preoperative scan, and clip clinical target volume (CTV) (clips with a 5-mm margin on the postoperative scan) was then studied, by use of commercial volume analysis software. RESULTS Of the patients, 4 had two clips, 2 had three clips, 8 had four clips, and 8 had five clips. The median GTV was 1.06 mL (range, 0.2-5.3 mL); clip CTV ranged from 2.4 to 21.5 mL. Volumetric analysis showed that in 7 cases (32%), there was no intersection between the GTV and the clip CTV, with the following distribution: 4 patients with two clips, 1 patient with three clips, 1 patient with four clips, and 1 patient with five clips. The common contoured volume was defined as the percent ratio between the intersection of the GTV and clip CTV and the GTV. It was found to be significantly increased if three or more clips were used vs. only two clips (common contoured volume, 35.45% vs. 0.73%; p = 0.028). Finally, the GTV and clip CTV volume relationship can be presented as follows: 12.5% to 33% overlap in 8 patients (36.4%), 50% to 75% in 5 patients (22.7%), and greater than 90% in 2 patients (9%). CONCLUSIONS The use of three or more clips during tumorectomy increases the accuracy of tumor bed delineation.
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Affiliation(s)
- Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France.
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Dzhugashvili M, Pichenot C, Dunant A, Balleyguier C, Delaloge S, Mathieu MC, Garbay JR, Marsiglia H, Bourgier C. Surgical Clips Assist in the Visualization of the Lumpectomy Cavity in Three-Dimensional Conformal Accelerated Partial-Breast Irradiation. Int J Radiat Oncol Biol Phys 2010; 76:1320-4. [PMID: 19596169 DOI: 10.1016/j.ijrobp.2009.04.089] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/30/2009] [Accepted: 04/03/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Maia Dzhugashvili
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
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Kim LH, DeCesare S, Vicini F, Yan D. Effect of lumpectomy cavity volume change on the clinical target volume for accelerated partial breast irradiation: a deformable registration study. Int J Radiat Oncol Biol Phys 2010; 78:1121-6. [PMID: 20207493 DOI: 10.1016/j.ijrobp.2009.09.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 09/16/2009] [Accepted: 09/17/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Previous studies have shown that lumpectomy cavity volumes can change significantly in the weeks following surgery. The effect of this volume change on the surrounding tissue that constitutes the clinical target volume (CTV) for accelerated partial breast irradiation and boost treatment after whole breast irradiation has not been previously studied. In the present study, we used deformable registration to estimate the effect of lumpectomy cavity volume changes on the CTV for accelerated partial breast irradiation and discuss the implications for target construction. METHODS AND MATERIALS The data from 13 accelerated partial breast irradiation patients were retrospectively analyzed. Deformable registration was used to propagate contours from the initial planning computed tomography scan to a later computed tomography scan acquired at the start of treatment. The changes in cavity volume and CTV, distance between cavity and CTV contours (i.e., CTV margin), and CTV localization error after cavity registration were determined. RESULTS The mean ± standard deviation change in cavity volume and CTV between the two computed tomography scans was -35% ± 23% and -14% ± 12%, respectively. An increase in the cavity-to-CTV margin of 2 ± 2 mm was required to encompass the CTV, and this increase correlated with the cavity volume change. Because changes in the cavity and CTV were not identical, a localization error of 2-3 mm in the CTV center of mass occurred when the cavity was used as the reference for image guidance. CONCLUSION Deformable registration suggested that CTV margins do not remain constant as the cavity volume changes. This finding has implications for planning target volume and CTV construction.
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Affiliation(s)
- Leonard H Kim
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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