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Jin Y, Zhao C, Wang L, Su Y, Shang D, Li F, Wang J, Liu X, Li J, Wang W. Target volumes comparison between postoperative simulation magnetic resonance imaging and preoperative diagnostic magnetic resonance imaging for prone breast radiotherapy after breast-conserving surgery. Cancer Med 2024; 13:e6956. [PMID: 38247382 PMCID: PMC10905334 DOI: 10.1002/cam4.6956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/27/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND This study investigated the differences in target volumes between preoperative magnetic resonance imaging (MRIpre) and postoperative MRI (MRIpost) for breast radiotherapy after breast-conserving surgery (BCS) using deformable image registration (DIR). METHODS AND MATERIALS Seventeen eligible patients who underwent whole-breast irradiation in the prone position after BCS were enrolled. On MRIpre, the gross tumor volume (GTV) was delineated as GTVpre, which was then expanded by 10 mm to represent the preoperative lumpectomy cavity (LC), denoted as LCpre. The LC was expanded to the clinical target volume (CTV) and planning target volume (PTV) on the MRIpre and MRIpost, denoted as CTVpre, CTVpost, PTVpre, and PTVpost, respectively. The MIM software system was used to register the MRIpre and MRIpost using DIR. Differences were evaluated regarding target volume, distance between the centers of mass (dCOM), conformity index (CI), and degree of inclusion (DI). The relationship between CILC /CIPTV and the clinical factors was also assessed. RESULTS Significant differences were observed in LC and PTV volumes between MRIpre and MRIpost (p < 0.0001). LCpre was 0.85 cm3 larger than LCpost, while PTVpre was 29.38 cm3 smaller than PTVpost. The dCOM between LCpre and LCpost was 1.371 cm, while that between PTVpre and PTVpost reduced to 1.348 cm. There were statistically significant increases in CI and DI for LCpost-LCpre and PTVpost-PTVpre (CI = 0.221, 0.470; DI = 0.472, 0.635). No obvious linear correlations (p > 0.05) were found between CI and GTV, primary tumor volume-to-breast volume ratio, distance from the primary tumor to the nipple and chest wall, and body mass index. CONCLUSIONS Despite using DIR technology, the spatial correspondence of target volumes between MRIpre and MRIpost was suboptimal. Therefore, relying solely on preoperative diagnostic MRI with DIR for postoperative LC delineation is not recommended.
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Affiliation(s)
- Ying Jin
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Changhui Zhao
- Department of Oncology, Jinan Third People's HospitalJinan Cancer HospitalJinanChina
| | - Lizhen Wang
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Ya Su
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Dongping Shang
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Jinzhi Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Xijun Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
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Zhao C, Li J, Wang W, Gong G, Xu L, Zhang Y, Li F, Shao Q, Wang J, Liu X, Xu M. DE-MR simulation imaging for prone radiotherapy after breast-conserving surgery: assessing its application in lumpectomy cavity delineation based on deformable image registration. Radiat Oncol 2021; 16:91. [PMID: 34001182 PMCID: PMC8130288 DOI: 10.1186/s13014-021-01817-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background The application of delayed-enhancement magnetic resonance (DE-MR) simulation imaging in lumpectomy cavity (LC) delineation for prone radiotherapy in patients with an invisible seroma or a low seroma clarity score (SCS) after breast-conserving surgery (BCS) based on deformable image registration (DIR) was assessed. Methods Twenty-six patients who were suitable for radiotherapy in prone positions after BCS were enrolled, and both computed tomography (CT) and DE-MR simulation scans were acquired. The LC delineated based on titanium surgical clips on CT images was denoted as LCCT. The LC delineated based on the signal of cavity boundaries on fat-suppressed T2-weighted imaging (T2WI) and multiphase delayed-enhancement T1-weighted imaging (DE-T1WI), which was performed at 2 min, 5 min and 10 min postinjection, were denoted as LCT2, LC2T1, LC5T1 and LC10T1, respectively. Afterwards, DIR was performed to compare the volumes and locations of the LCs with MIM software. The generalized conformity index (CIgen) of inter (intra) observer (Inter-CIgen and Intra-CIgen) was also used to explore the inter(intra) observer variation for LC delineation on each image modality. Results LCCT–LC10T1 provided the best conformal index (CI) and degree of inclusion (DI), increasing by 2.08% and 4.48% compared to LCCT–LCT2, 11.36% and 2.94% for LCCT–LC2T1, and 8.89% and 7.69% for LC5T1–LCCT, respectively. The center of mass (COM) of LCCT–LC10T1 decreased by 17.86%, 6.12% and 13.21% compared with that of LCCT–LCT2, LCCT–LC2T1 and LCCT–LC5T1, respectively. The agreement of LC delineation was strongest for 10th min DE-TIWI (coefficient of variation, COV = 2.30%, Inter-CIgen = 87.06%, Intra-CIgen = 92.64%). Conclusion For patients with a low SCS (SCS ≤ 2) after BCS, it is feasible to contour the LC based on prone DE-MR simulation images. Furthermore, the LC derived from prone DE-T1WI at 10 min was found to be most similar to that derived from prone CT simulation scans using titanium surgical clips regardless of the volume and location of the LC. Inter (intra) variability was minimal for the delineation of the LC based on 10th min DE-TIWI.
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Affiliation(s)
- Changhui Zhao
- School of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
| | - Guanzhong Gong
- Department of Medical Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Liang Xu
- Department of Medical Imagings, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Jinzhi Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Xijun Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, 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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Gschwend PM, Hintze JM, Herrmann IK, Pratsinis SE, Starsich FHL. Precision in Thermal Therapy: Clinical Requirements and Solutions from Nanotechnology. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202000193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Pascal M. Gschwend
- Particle Technology Laboratory Department of Mechanical and Process Engineering ETH Zurich Sonneggstrasse 3 Zurich CH‐8092 Switzerland
| | - Justin M. Hintze
- Royal College of Surgeons in Ireland 123 St Stephen's Green, Saint Peter's Dublin 2 D02 YN77 Ireland
| | - Inge K. Herrmann
- Particles‐Biology Interactions Department Materials Meet Life Swiss Federal Laboratories for Materials Science and Technology (Empa) Lerchenfeldstrasse 5 St. Gallen CH‐9014 Switzerland
- Nanoparticle Systems Engineering Laboratory Department of Mechanical and Process Engineering ETH Zurich Sonneggstrasse 3 Zurich CH‐8092 Switzerland
| | - Sotiris E. Pratsinis
- Particle Technology Laboratory Department of Mechanical and Process Engineering ETH Zurich Sonneggstrasse 3 Zurich CH‐8092 Switzerland
| | - Fabian H. L. Starsich
- Particles‐Biology Interactions Department Materials Meet Life Swiss Federal Laboratories for Materials Science and Technology (Empa) Lerchenfeldstrasse 5 St. Gallen CH‐9014 Switzerland
- Nanoparticle Systems Engineering Laboratory Department of Mechanical and Process Engineering ETH Zurich Sonneggstrasse 3 Zurich CH‐8092 Switzerland
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Leonardi MC, Tomio L, Radice D, Takanen S, Bonzano E, Alessandro M, Ciabattoni A, Ivaldi GB, Bagnardi V, Alessandro O, Francia CM, Fodor C, Miglietta E, Veronesi P, Galimberti VE, Orecchia R, Tagliaferri L, Vidali C, Massaccesi M, Guenzi M, Jereczek-Fossa BA. Local Failure After Accelerated Partial Breast Irradiation with Intraoperative Radiotherapy with Electrons: An Insight into Management and Outcome from an Italian Multicentric Study. Ann Surg Oncol 2019; 27:752-762. [DOI: 10.1245/s10434-019-08075-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Indexed: 12/19/2022]
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Bali R, Kankam HKN, Borkar N, Provenzano E, Agrawal A. Wide Local Excision Versus Oncoplastic Breast Surgery: Differences in Surgical Outcome for an Assumed Margin (0, 1, or 2 mm) Distance. Clin Breast Cancer 2018; 18:e1053-e1057. [PMID: 30006254 DOI: 10.1016/j.clbc.2018.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Oncoplastic breast surgery (OBS) can be applied in larger tumors or in patients with high tumor-to-breast ratio without compromising oncologic safety. Inherent larger excisions may increase the probability of clear margins. We compare postoperative outcomes between simple wide local excision (WLE) and OBS assuming 3 different margin distances. PATIENTS AND METHODS Single oncoplastic surgeon data between April 2014 and September 2016, including tumor and treatment details, for WLE or OBS were reviewed. Relative incidence of margin positivity at 3 assumed distinct margin distances (2, 1, and 0 mm) and reexcision rates were compared. Statistical comparisons were performed by the Student t and chi-square tests. RESULTS Available data from 201 patients revealed similar patient age and respective tumor phenotypes between 2 cohorts (166 WLE and 35 OBS). Though both the preoperative (30 vs. 16 mm, P < .001) and postoperative tumor (30 vs. 19 mm, P = .001) sizes were greater in the OBS group, margin positivity rates were significantly lower, at 1 mm (5.7% vs. 20.8%, P = .036). Though similar rates of reexcision were observed, completion mastectomies were required in 5.4% of WLE versus 0 OBS. Similar rates of margin positivity and reexcision were observed between mammoplasties and chest wall perforator flaps. CONCLUSION OBS is not inferior to standard WLE at providing a safe and clear oncologic margin regardless of margin distance (up to 2 mm) despite larger tumor size. The additional benefit of improved cosmesis, particularly in patients with larger tumor-to-breast ratio, offers a suitable and safe alternative, thus increasing patient choice and reducing the incidence of reexcision and completion mastectomy.
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Affiliation(s)
- Radhika Bali
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Hadyn K N Kankam
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Nikhilesh Borkar
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elena Provenzano
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Amit Agrawal
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Zhang A, Li J, Qiu H, Wang W, Guo Y. Comparison of rigid and deformable registration through the respiratory phases of four-dimensional computed tomography image data sets for radiotherapy after breast-conserving surgery. Medicine (Baltimore) 2017; 96:e9143. [PMID: 29390317 PMCID: PMC5815729 DOI: 10.1097/md.0000000000009143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the geometric differences in gross tumor volume (GTV) and surgical clips propagated by rigid image registration (RIR) and deformable image registration (DIR) using a four-dimensional computed tomography (4DCT) image data set for patients treated with boost irradiation or accelerated partial breast irradiation after breast-conserving surgery (BCS). METHODS The 4DCT data sets of 44 patients who had undergone BCS were acquired. GTV and selected clips were manually delineated on end-inhalation phase (CT0) and end-exhalation phase (CT50) images of 4DCT data sets. Subsequently, the GTV and selected clips from CT0 images were transformed and propagated to CT50 images using RIR and DIR, respectively. The geometric differences in GTV and surgical clips from DIR were compared with those of RIR. RESULTS The mean Dice similarity coefficient (DSC) index was 0.860 ± 0.042 for RIR and 0.870 ± 0.040 for DIR for GTV (P = .000). The three-dimensional distance to the center of mass (COM) of the GTV from RIR was longer than that from DIR (1.22 mm and 1.10 mm, respectively, P = .000). Moreover, in the anterior-posterior direction, displacements from RIR were significantly greater than those from DIR for both GTV (0.70 mm and 0.50 mm, respectively) and selected clips (upper clip, 0.45 mm vs 0.20 mm; inner clip, 0.55 mm vs 0.30 mm; outer clip, 0.40 mm vs 0.20 mm; lower clip, 0.50 mm vs 0.25 mm) (P = .000). However, in the left-right and superior-inferior directions, there were no significant displacement differences between RIR and DIR for GTV and the selected clips (all P > .050). CONCLUSION DIR can improve the overlap for GTV registration from CT0 to CT50 images from 4DCT scanning. Furthermore, DIR is superior to RIR in reflecting the displacement of GTV and selected clips in the anterior-posterior direction induced by respiratory movement.
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Affiliation(s)
- Aiping Zhang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
- Department of Radiation Oncology
- The Third Hospital of Jinan, China
| | | | - Heng Qiu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province
| | - Wei Wang
- Department of Radiation Oncology
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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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Ciardo D, Argenone A, Boboc GI, Cucciarelli F, De Rose F, De Santis MC, Huscher A, Ippolito E, La Porta MR, Marino L, Meaglia I, Palumbo I, Rossi F, Alpi P, Bignardi M, Bonanni A, Cante D, Ceschia T, Fabbietti L, Lupattelli M, Mantero ED, Monaco A, Porcu P, Ravo V, Silipigni S, Tozzi A, Umina V, Zerini D, Bordonaro L, Capezzali G, Clerici E, Colangione SP, Dispinzieri M, Dognini J, Donadoni L, Falivene S, Fozza A, Grilli B, Guarnaccia R, Iannacone E, Lancellotta V, Prisco A, Ricotti R, Orecchia R, Jereczek-Fossa BA, Leonardi MC. Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform. Acta Oncol 2017; 56:1081-1088. [PMID: 28534430 DOI: 10.1080/0284186x.2017.1325004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To quantify the variability between radiation oncologists (ROs) when outlining axillary nodes in breast cancer. MATERIAL AND METHODS For each participating center, three ROs with different levels of expertise, i.e., junior (J), senior (S) and expert (E), contoured axillary nodal levels (L1, L2, L3 and L4) on the CT images of three different patients (P) of an increasing degree of anatomical complexity (from P1 to P2 to P3), according to contouring guidelines. Consensus contours were generated using the simultaneous truth and performance level estimation (STAPLE) method. RESULTS Fifteen centers and 42 ROs participated. Overall, the median Dice similarity coefficient was 0.66. Statistically significant differences were observed according to the level of expertise (better agreement for J and E, worse for S); the axillary level (better agreement for L1 and L4, worse for L3); the patient (better agreement for P1, worse for P3). Statistically significant differences in contouring were found in 18% of the inter-center comparison. Less than a half of the centers could claim to have a good agreement between the internal ROs. CONCLUSIONS The overall intra-institute and inter-institute agreement was moderate. Central lymph-node levels were the most critical and variability increased as the complexity of the patient's anatomy increased. These findings might have an effect on the interpretation of results from multicenter and even mono-institute studies.
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Affiliation(s)
- Delia Ciardo
- Division of Radiation Oncology, Istituto Europeo di Oncologia, Milano, Italy
| | - Angela Argenone
- Division of Radiotherapy, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale IRCCS, Napoli, Italy
| | | | - Francesca Cucciarelli
- Department of Internal Medicine, Radiotherapy Institute, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy
| | - Fiorenza De Rose
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Centre and Research Hospital, Milano, Italy
| | | | | | - Edy Ippolito
- Department of Radiotherapy, Campus Bio-Medico University, Roma, Italy
| | - Maria Rosa La Porta
- Radiotherapy Department, Ivrea Community Hospital, Ivrea, Italy; Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale ‘U. Parini’, AUSL Valle d'Aosta, Aosta, Italy
| | - Lorenza Marino
- REM Radioterapia, Istituto Oncologico del Mediterraneo (IOM), Catania, Italy
| | - Ilaria Meaglia
- Department of Radiation Oncology, Fondazione Salvatore Maugeri, Pavia, Italy
| | - Isabella Palumbo
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Paolo Alpi
- Radiotherapy Unit, Azienda Sanitaria 10, Firenze, Italy
| | - Mario Bignardi
- Radiotherapy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Alessio Bonanni
- Radiotherapy Unit, Ospedale Fatebenefratelli Isola Tiberina, Roma, Italy
| | - Domenico Cante
- Radiotherapy Department, Ivrea Community Hospital, Ivrea, Italy; Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale ‘U. Parini’, AUSL Valle d'Aosta, Aosta, Italy
| | - Tino Ceschia
- Department of Radiotherapy, Azienda Sanitaria Universitaria Integrata Santa Maria della Misericordia, Udine, Italy
| | - Letizia Fabbietti
- Department of Internal Medicine, Radiotherapy Institute, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy
| | - Marco Lupattelli
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Alessia Monaco
- Department of Radiation Oncology, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Patrizia Porcu
- Department of Radiation Oncology, Fondazione Salvatore Maugeri, Pavia, Italy
| | - Vincenzo Ravo
- Division of Radiotherapy, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale IRCCS, Napoli, Italy
| | - Sonia Silipigni
- Department of Radiotherapy, Campus Bio-Medico University, Roma, Italy
| | - Angelo Tozzi
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Centre and Research Hospital, Milano, Italy
| | - Vincenza Umina
- REM Radioterapia, Istituto Oncologico del Mediterraneo (IOM), Catania, Italy
| | - Dario Zerini
- Division of Radiation Oncology, Istituto Europeo di Oncologia, Milano, Italy
| | - Luigi Bordonaro
- REM Radioterapia, Istituto Oncologico del Mediterraneo (IOM), Catania, Italy
| | - Giorgia Capezzali
- Department of Internal Medicine, Radiotherapy Institute, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Centre and Research Hospital, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | | | - Michela Dispinzieri
- Radiotherapy Unit 1, National Cancer Institute of Milan, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Jessica Dognini
- Department of Radiation Oncology, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Laura Donadoni
- Radiotherapy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Sara Falivene
- Division of Radiotherapy, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale IRCCS, Napoli, Italy
| | - Alessandra Fozza
- Radiotherapy Department, Ivrea Community Hospital, Ivrea, Italy; Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale ‘U. Parini’, AUSL Valle d'Aosta, Aosta, Italy
| | | | - Roberta Guarnaccia
- Radiotherapy Unit, Ospedale Fatebenefratelli Isola Tiberina, Roma, Italy
| | - Eva Iannacone
- Department of Radiotherapy, Campus Bio-Medico University, Roma, Italy
| | - Valentina Lancellotta
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Agnese Prisco
- Department of Radiotherapy, Azienda Sanitaria Universitaria Integrata Santa Maria della Misericordia, Udine, Italy
| | - Rosalinda Ricotti
- Division of Radiation Oncology, Istituto Europeo di Oncologia, Milano, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, Istituto Europeo di Oncologia, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
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10
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Jeon SH, Shin KH, Park SY, Kim JI, Park JM, Kim JH, Chie EK, Wu HG. Seroma change during magnetic resonance imaging-guided partial breast irradiation and its clinical implications. Radiat Oncol 2017. [PMID: 28633637 PMCID: PMC5477744 DOI: 10.1186/s13014-017-0843-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background To investigate the patterns of post-lumpectomy seroma volume (SV) change and related clinical factors to determine the benefits of adaptive planning in magnetic resonance imaging (MRI)-guided partial breast irradiation (PBI). Methods MRI data obtained from 37 women with early breast cancer acquired at simulation and at the 1st, 6th, and 10th fractions were analyzed. The planning target volume (PTV) was defined as unequal margins of 10–15 mm added according to the directional surgical margin status of each seroma. Treatment was performed using a 0.35 T MRI-guided radiotherapy system. Univariate analysis was performed to assess the correlations between SV change rate and clinical factors. Seroma and PTV for adaptive planning were based on the images obtained at the 6th fraction. Results The average time intervals between surgery-simulation, simulation-1st, 1st-6th, and 6th-10th fractions were 23.1, 8.5, 7.2, and 5.9 days, respectively. Of the 37 patients, 33 exhibited decreased SV over the treatment period. The mean SV of these 33 patients decreased from 100% at simulation to 60, 48, and 40% at each MRI scan. In most cases (26/33), the logarithm of SV was inversely proportional to the elapsed time from surgery (R2 > 0.90, Pearson’s correlation test). The volume of spared normal tissue from adaptive radiotherapy was proportional to the absolute change in SV (R2 = 0.89, Pearson’s correlation test). Conclusion Seromas exhibit exponential shrinkage over the course of PBI. In patients receiving PBI, frequent monitoring of SV could be helpful in decision-making regarding adaptive planning, especially those with a large seroma.
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Affiliation(s)
- Seung Hyuck Jeon
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea. .,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| | - So-Yeon Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jung-In Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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11
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Intraoperative Radiotherapy with Electrons (ELIOT). Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Snider JW, Mutaf Y, Nichols E, Hall A, Vadnais P, Regine WF, Feigenberg SJ. Dosimetric Improvements with a Novel Breast Stereotactic Radiotherapy Device for Delivery of Preoperative Partial-Breast Irradiation. Oncology 2016; 92:21-30. [PMID: 27898429 DOI: 10.1159/000449388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/12/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Partial-breast irradiation (PBI) with external-beam radiotherapy has produced higher than expected rates of fair-to-poor cosmesis. Worsened outcomes have been correlated with larger volumes of breast tissue exposed to radiation. A novel breast-specific stereotactic radiotherapy (BSRT) device (BSRTD) has been developed at our institution and has shown promise in delivering highly conformal dose distributions. We compared normal tissue sparing with this device with that achieved with intensity-modulated radiation therapy (IMRT)-PBI. METHODS Fifteen women previously treated with breast conservation therapy were enrolled on an institutional review board-approved protocol. Each of them underwent CT simulation in the prone position using the BSRTD-specific immobilization system. Simulated postoperative and preoperative treatment volumes were generated based on surgical bed/clip position. Blinded planners generated IMRT-PBI plans and BSRT plans for each set of volumes. These plans were compared based on clinically validated markers for cosmetic outcome and toxicity using a Wilcoxon rank-sum test. RESULTS The BSRT plans consistently reduced the volumes receiving each of several dose levels (Vx) to breast tissue, the chest wall, the lung, the heart, and the skin in both preoperative and postoperative settings (p < 0.05). Preoperative BSRT yielded particularly dramatic improvements. CONCLUSION The novel BSRTD has demonstrated significant dosimetric benefits over IMRT-PBI. Further investigation is currently proceeding through initial clinical trials.
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Affiliation(s)
- James W Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
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13
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Leonardi MC, Ricotti R, Dicuonzo S, Cattani F, Morra A, Dell'Acqua V, Orecchia R, Jereczek-Fossa BA. From technological advances to biological understanding: The main steps toward high-precision RT in breast cancer. Breast 2016; 29:213-22. [DOI: 10.1016/j.breast.2016.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/27/2016] [Accepted: 07/08/2016] [Indexed: 12/23/2022] Open
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14
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Bittermann G, Ermer M, Voss P, Duttenhoefer F, Zimmerer R, Schmelzeisen R, Metzger MC. Comparison of virtual and titanium clip marking of tumour resection margins for improved radiation planning in head and neck cancer surgery. Int J Oral Maxillofac Surg 2015; 44:1468-73. [PMID: 26265065 DOI: 10.1016/j.ijom.2015.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/09/2015] [Accepted: 07/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- G Bittermann
- Department of Oral and Maxillofacial Surgery, University Medical Centre Freiburg, Freiburg, Germany.
| | - M Ermer
- Department of Oral and Maxillofacial Surgery, University Medical Centre Freiburg, Freiburg, Germany
| | - P Voss
- Department of Oral and Maxillofacial Surgery, University Medical Centre Freiburg, Freiburg, Germany
| | - F Duttenhoefer
- Department of Oral and Maxillofacial Surgery, University Medical Centre Freiburg, Freiburg, Germany
| | - R Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - R Schmelzeisen
- Department of Oral and Maxillofacial Surgery, University Medical Centre Freiburg, Freiburg, Germany
| | - M C Metzger
- Department of Oral and Maxillofacial Surgery, University Medical Centre Freiburg, Freiburg, Germany
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15
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Jacob J, Heymann S, Borget I, Dumas I, Riahi E, Maroun P, Ezra P, Roberti E, Rivera S, Deutsch E, Bourgier C. Dosimetric Effects of the Interfraction Variations during Whole Breast Radiotherapy: A Prospective Study. Front Oncol 2015; 5:199. [PMID: 26442211 PMCID: PMC4584980 DOI: 10.3389/fonc.2015.00199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022] Open
Abstract
Introduction The aim of this work was to assess the dosimetric impact of the interfraction variations during breast radiotherapy. Materials and methods Daily portal imaging measurements were prospectively performed in 10 patients treated with adjuvant whole breast irradiation (50 Gy/25 fractions). Margins between the clinical target volume and the planning target volume (PTV) were 5 mm in the three dimensions. Parameters of interest were the central lung distance (CLD) and the inferior central margin (ICM). Daily movements were applied to the baseline treatment planning (TP1) to design a further TP (TP2). The PTV coverage and organ at risk exposure were measured on both TP1 and TP2, before being compared. Results A total of 241 portal images were analyzed. The random and systematic errors were 2.6 and 3.7 mm for the CLD, 4.3 and 6.9 mm for the ICM, respectively. No significant consequence on the PTV treatments was observed (mean variations: +0.1%, p = 0.56 and −1.8%, p = 0.08 for the breast and the tumor bed, respectively). The ipsilateral lung and heart exposure was not significantly modified. Conclusion In our series, the daily interfraction variations had no significant effect on the PTV coverage or healthy tissue exposure during breast radiotherapy.
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Affiliation(s)
- Julian Jacob
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Steve Heymann
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Isabelle Borget
- Department of Biostatistics and Epidemiology, Gustave Roussy , Villejuif , France ; University Paris-Sud , Kremlin-Bicêtre , France
| | - Isabelle Dumas
- Department of Physics, Gustave Roussy , Villejuif , France
| | - Elyes Riahi
- Department of Physics, Gustave Roussy , Villejuif , France
| | - Pierre Maroun
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Patrick Ezra
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Elena Roberti
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Sofia Rivera
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Eric Deutsch
- Department of Radiotherapy, Gustave Roussy , Villejuif , France ; University Paris-Sud , Kremlin-Bicêtre , France
| | - Céline Bourgier
- Department of Oncologic Radiotherapy, Institut du Cancer de Montpellier , Montpellier , France
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16
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Bittermann G, Thönissen P, Poxleitner P, Zimmerer R, Vach K, Metzger MC. Microvascular transplants in head and neck reconstruction: 3D evaluation of volume loss. J Craniomaxillofac Surg 2015; 43:1319-24. [DOI: 10.1016/j.jcms.2015.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022] Open
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17
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Bittermann G, Voss P, Duttenhoefer F, Zimmerer R, Vach K, Metzger MC. The validity of surgical clips as radiographic markers for the tumour resection cavity in head and neck cancer treatment. J Craniomaxillofac Surg 2015; 43:758-62. [DOI: 10.1016/j.jcms.2015.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 03/24/2015] [Accepted: 04/02/2015] [Indexed: 11/16/2022] Open
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18
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Bittermann G, Wiedenmann N, Bunea A, Schwarz SJ, Grosu AL, Schmelzeisen R, Metzger MC. Clipping of tumour resection margins allows accurate target volume delineation in head and neck cancer adjuvant radiation therapy. Radiother Oncol 2015; 116:82-6. [DOI: 10.1016/j.radonc.2015.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 04/30/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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19
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Recommendations from GEC ESTRO Breast Cancer Working Group (I): Target definition and target delineation for accelerated or boost Partial Breast Irradiation using multicatheter interstitial brachytherapy after breast conserving closed cavity surgery. Radiother Oncol 2015; 115:342-8. [DOI: 10.1016/j.radonc.2015.06.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/08/2015] [Accepted: 06/08/2015] [Indexed: 11/18/2022]
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20
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Marking of tumor resection borders for improved radiation planning facilitates reduction of radiation dose to free flap reconstruction in head and neck cancer surgery. J Craniomaxillofac Surg 2015; 43:567-73. [DOI: 10.1016/j.jcms.2015.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 01/22/2023] Open
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21
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Nardone L, Diletto B, De Santis MC, D' Agostino GR, Belli P, Bufi E, Franceschini G, Mulé A, Sapino A, Terribile D, Valentini V. Primary systemic treatment and concomitant low dose radiotherapy for breast cancer: Final results of a prospective phase II study. Breast 2014; 23:597-602. [DOI: 10.1016/j.breast.2014.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/14/2014] [Accepted: 06/05/2014] [Indexed: 11/17/2022] Open
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22
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Quirk S, Conroy L, Smith WL. When is respiratory management necessary for partial breast intensity modulated radiotherapy: A respiratory amplitude escalation treatment planning study. Radiother Oncol 2014; 112:402-6. [PMID: 25236712 DOI: 10.1016/j.radonc.2014.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 07/15/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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23
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Roth AM, Kauer-Dorner D, Resch A, Schmid A, Thill M, Niehoff P, Melchert C, Berger D, Kovács G. Is oncoplastic surgery a contraindication for accelerated partial breast radiation using the interstitial multicatheter brachytherapy method? Brachytherapy 2014; 13:394-9. [DOI: 10.1016/j.brachy.2013.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/06/2013] [Accepted: 09/07/2013] [Indexed: 10/25/2022]
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Abstract
The eligibility criteria for partial breast irradiation (APBI) are mainly based on histopathological factors, which not always explain the clinical behaviour of breast cancers. International guidelines represent useful platform to collect data for continued refinement of patient selection, but the clinical applicability to APBI series showed some limitations, particularly among the intermediate and high-risk groups. The heterogeneity of APBI techniques, along with the heterogeneity of breast cancer, generates clinical results, where the predictive value of the histopathological factors can assume different weight. There is a need of further refinement and implementation of risk factors. Currently, the impact of breast cancer subtype on local control is matter of investigation, and treatment decision about radiotherapy is generally made without regard to the breast cancer subtype. However, receptor status information is easily available and some histopathological factors have not a definite role, there is no uniform interpretation. As molecular classification becomes more feasible in the clinical practice, it will provide added value to conventional clinical tumour characteristics in predicting local recurrence in breast cancer and may play an important role as predictor of eventual patient outcomes.
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25
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Ding Y, Li J, Wang W, Wang S, Wang J, Ma Z, Shao Q, Xu M. A comparative study on the volume and localization of the internal gross target volume defined using the seroma and surgical clips based on 4DCT scan for external-beam partial breast irradiation after breast conserving surgery. Radiat Oncol 2014; 9:76. [PMID: 24646022 PMCID: PMC3994573 DOI: 10.1186/1748-717x-9-76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 03/09/2014] [Indexed: 11/19/2022] Open
Abstract
Background To explore the volume and localization of the internal gross target volume defined using the seroma and/or surgical clips based on the four-dimensional computed tomography (4DCT) during free-breathing. Methods Fifteen breast cancer patients after breast-conserving surgery (BCS) were recruited for EB-PBI. On the ten sets CT images, the gross target volume formed by the clips, the seroma, both the clips and seroma delineated by one radiation oncologist and defined as GTVc, GTVs and GTVc + s, respectively. The ten GTVc, GTVs and GTVc + s on the ten sets CT images produced the IGTVc, IGTVs, IGTVc + s, respectively. The IGTV volume and the distance between the center of IGTVc, IGTVs, IGTVc + s were all recorded. Conformity index (CI), degree of inclusion (DI) were calculated for IGTV/IGTV, respectively. Results The volume of IGTVc + s were significantly larger than the IGTVc and IGTVs (p < 0.05). There was significant difference between the DIs of IGTVc vs IGTVc + s, the DIs of IGTVs vs IGTVc + s. There was significant difference among the CIs of IGTV/IGTV. The DIs and CIs of IGTV/IGTV were negatively correlated with their centroid distance (r < 0, p < 0.05). Conclusions There were volume difference and spatial mismatch between the IGTVs delineated based on the surgical clips and seroma. The IGTV defined as the seroma and surgical clips provided the best overall representation of the ‘true’ moving GTV.
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Affiliation(s)
| | - Jianbin Li
- Department of Radiation Oncology (Chest section), Shandong Tumor Hospital, Jinan, Shandong Province, 250117, People's Republic of China.
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Landry A, Berrang T, Gagne I, Popescu C, Mitchell T, Vey H, Sand L, Soh SY, Wark J, Olivotto I, Beckham W. Investigation of variability in image acquisition and contouring during 3D ultrasound guidance for partial breast irradiation. Radiat Oncol 2014; 9:35. [PMID: 24467876 PMCID: PMC3996185 DOI: 10.1186/1748-717x-9-35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 01/09/2014] [Indexed: 12/02/2022] Open
Abstract
Background Three-dimensional ultrasound (3DUS) at simulation compared to 3DUS at treatment is an image guidance option for partial breast irradiation (PBI). This study assessed if user dependence in acquiring and contouring 3DUS (operator variability) contributed to variation in seroma shifts calculated for breast IGRT. Methods Eligible patients met breast criteria for current randomized PBI studies. 5 Operators participated in this study. For each patient, 3 operators were involved in scan acquisitions and 5 were involved in contouring. At CT simulation (CT1), a 3DUS (US1) was performed by a single radiation therapist (RT). 7 to 14 days after CT1 a second CT (CT2) and 3 sequential 3DUS scans (US2a,b,c) were acquired by each of 3 RTs. Seroma shifts, between US1 and US2 scans were calculated by comparing geometric centers of the seromas (centroids). Operator contouring variability was determined by comparing 5 RT’s contours for a single image set. Scanning variability was assessed by comparing shifts between multiple scans acquired at the same time point (US1-US2a,b,c). Shifts in seromas contoured on CT (CT1-CT2) were compared to US data. Results From an initial 28 patients, 15 had CT visible seromas, met PBI dosimetric constraints, had complete US data, and were analyzed. Operator variability contributed more to the overall variability in seroma localization than the variability associated with multiple scan acquisitions (95% confidence mean uncertainty of 6.2 mm vs. 1.1 mm). The mean standard deviation in seroma shift was user dependent and ranged from 1.7 to 2.9 mm. Mean seroma shifts from simulation to treatment were comparable to CT. Conclusions Variability in shifts due to different users acquiring and contouring 3DUS for PBI guidance were comparable to CT shifts. Substantial inter-observer effect needs to be considered during clinical implementation of 3DUS IGRT.
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Affiliation(s)
- Anthony Landry
- Radiation Therapy Program, Prince Edward Island Cancer Treatment Centre, Charlottetown, PE, Canada.
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van der Leij F, Elkhuizen PHM, Janssen TM, Poortmans P, van der Sangen M, Scholten AN, van Vliet-Vroegindeweij C, Boersma LJ. Target volume delineation in external beam partial breast irradiation: less inter-observer variation with preoperative- compared to postoperative delineation. Radiother Oncol 2013; 110:467-70. [PMID: 24262820 DOI: 10.1016/j.radonc.2013.10.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 10/07/2013] [Accepted: 10/24/2013] [Indexed: 11/24/2022]
Abstract
The challenge of adequate target volume definition in external beam partial breast irradiation (PBI) could be overcome with preoperative irradiation, due to less inter-observer variation. We compared the target volume delineation for external beam PBI on preoperative versus postoperative CT scans of twenty-four breast cancer patients.
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Affiliation(s)
- Femke van der Leij
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Paula H M Elkhuizen
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Radiation Oncology, Amsterdam, The Netherlands.
| | - Tomas M Janssen
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Philip Poortmans
- Institute Verbeeten, Department of Radiation Oncology, Tilburg, The Netherlands
| | | | - Astrid N Scholten
- Leiden University Medical Centre, Department of Radiation Oncology, The Netherlands
| | | | - Liesbeth J Boersma
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), The Netherlands
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Ding Y, Li J, Wang W, Wang S, Fan T, Xu M, Shao Q, Ma Z. Displacement of the lumpectomy cavity defined by surgical clips and seroma based on 4D-CT scan for external-beam partial breast irradiation after breast-conserving surgery: a comparative study. Br J Radiol 2013; 86:20130416. [PMID: 23995875 DOI: 10.1259/bjr.20130416] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the displacements of the lumpectomy cavity delineated by the surgical clips and the seroma based on four-dimensional CT (4D-CT) for external-beam partial breast irradiation (EB-PBI) after breast-conserving surgery (BCS). METHODS 14 breast cancer patients after BCS were recruited for EB-PBI and undertook 4D-CT simulation. On the 10 sets of the 4D-CT images, all the surgical clips in the cavity were delineated. The gross tumour volume (GTV) formed by the clips, the seroma, and both the clips and the seroma were defined as GTVc, GTVs and GTVc+s, respectively. The displacements of the centre of mass (COM) of the clips, GTVc, GTVs, GTVc+s and the selected clips in the three-dimensional (3D) directions were recorded and compared. RESULTS In the left-right, anterior-posterior and superior-inferior directions, the displacements were 2.20, 1.80 and 2.70 mm for the clip COM; 0.90, 1.05 and 1.20 mm for GTVc; 0.80, 1.05 and 0.80 mm for GTVs; and 0.90, 1.20 and 1.40 mm for GTVc+s, respectively. In the 3D directions, the displacements of the clip COM were greater than the GTVc, GTVs, GTVc+s, and the displacements of the clip COM, GTVc+s, GTVc and GTVs were significantly greater than the displacements of the selected clips (p<0.05). CONCLUSION The displacements of the clip COM were greater than that of the GTVc, GTVs, GTVc+s and the four selected clips. The optimal internal target volume should be defined based on the boundary displacements. ADVANCES IN KNOWLEDGE When the GTV was delineated using the clips and/or the seroma, there was displacement difference between the lumpectomy cavity centre and the boundary for the EB-PBI. The optimal internal target volume should be defined based on the boundary displacements of the lumpectomy cavity.
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Affiliation(s)
- Y Ding
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
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Yang TJ, Tao R, Elkhuizen PH, van Vliet-Vroegindeweij C, Li G, Powell SN. Tumor bed delineation for external beam accelerated partial breast irradiation: A systematic review. Radiother Oncol 2013; 108:181-9. [DOI: 10.1016/j.radonc.2013.05.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 05/12/2013] [Accepted: 05/12/2013] [Indexed: 11/15/2022]
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Preoperative radiation therapy significantly increases patient eligibility for accelerated partial breast irradiation using 3D-conformal radiotherapy. Am J Clin Oncol 2013; 36:232-8. [PMID: 22549267 DOI: 10.1097/coc.0b013e3182467ffd] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Three-dimensional-conformal radiation (3D-CRT) is the most common approach used in National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39 for accelerated partial breast irradiation (APBI). Administration of APBI-3D-CRT in the preoperative (preop) setting has been shown to decrease the planning target volume. The impact of this decrease on patient eligibility for APBI has not been evaluated in a comparative manner. MATERIALS AND METHODS Forty patients with 41 previously treated breast cancers (≤4 cm) were analyzed. A spherical preop tumor volume was created using the largest reported radiographic dimension and centered within the contoured lumpectomy cavity. Plans were created and optimized using the preop tumor volume and postoperative lumpectomy cavity using NSABP B-39 guidelines. The primary end point was to evaluate for differences in patient eligibility and normal tissue exposure. RESULTS Thirty-five tumors (85%) in the preop versus 19 tumors (46%) in the postoperative setting were eligible for 3D-CRT-APBI using NSABP B-39 criteria (P=0.0002). The most common reason for ineligibility was due to >60% of the ipsilateral breast volume receiving 50% of the dose. Other reasons included dose to the contralateral breast, heart, and ipsilateral lung. Preop 3D-CRT-APBI was associated with statistically significant improvements in dose sparing to the heart, ipsilateral normal breast tissue, contralateral breast, chest wall, ipsilateral lung, and skin. CONCLUSIONS Dosimetrically, the use of preop radiation would increase patient eligibility for 3D-CRT-APBI and decrease dose to normal tissues, which will potentially decrease toxicity and improve cosmesis. These results provide the basis for a recently activated prospective study of preop 3D-CRT-APBI.
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Leonardi MC, Maisonneuve P, Mastropasqua MG, Morra A, Lazzari R, Dell'Acqua V, Ferrari A, Rotmensz N, Sangalli C, Luini A, Veronesi U, Orecchia R. Accelerated partial breast irradiation with intraoperative electrons: using GEC-ESTRO recommendations as guidance for patient selection. Radiother Oncol 2012; 106:21-7. [PMID: 23218711 DOI: 10.1016/j.radonc.2012.10.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 10/30/2012] [Accepted: 10/31/2012] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate outcomes among early-stage breast cancer patients after conservative surgery and full-dose intraoperative radiotherapy electrons (ELIOT) by applying the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) recommendations for partial breast irradiation (APBI). MATERIALS AND METHODS One-thousand eight-hundred and twenty-two patients were stratified into the three GEC-ESTRO categories of "good candidates", "possible candidates" and "contraindication" in order to assess outcomes. RESULTS All the 1822 cases except 7 could be classified according to GEC-ESTRO groups: 573 patients met the criteria to be included in the "good candidates" group, 468 patients in the "possible candidates" group and 767 patients in the "contraindication" group. Median and mean follow-up length was 3.5 years (range 0-10.5 years) and 3.8 years (SD 2.2), respectively. The 5-year rate of in-breast tumor reappearances for "good candidates", "possible candidates" and "contraindication" groups were 1.9%, 7.4% and 7.7%, respectively (p 0.001). While the regional node relapse showed no difference, the rate of distant metastases was significantly different in the "contraindication" group compared to the other two categories, having a significant impact on survival. CONCLUSIONS Among the ELIOT population, the GEC-ESTRO recommendations enabled the selection of the good candidates with a low rate of local recurrence, but failed to differentiate the "possible candidates" and the "contraindication" groups.
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Nguyen BT, Deb S, Fox S, Hill P, Collins M, Chua BH. A Prospective Pathologic Study to Define the Clinical Target Volume for Partial Breast Radiation Therapy in Women With Early Breast Cancer. Int J Radiat Oncol Biol Phys 2012; 84:1116-22. [DOI: 10.1016/j.ijrobp.2012.02.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 11/24/2022]
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Moghaddasi L, Bezak E, Marcu LG. Current challenges in clinical target volume definition: tumour margins and microscopic extensions. Acta Oncol 2012; 51:984-95. [PMID: 22998477 DOI: 10.3109/0284186x.2012.720381] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Determination of optimal clinical target volume (CTV) margins around gross tumour volume (GTV) for modern radiotherapy techniques, requiring more precise target definitions, is controversial and complex. Tumour localisation has been greatly improved using molecular imaging integrated with conventional imaging techniques. However, the exact incidence and extent of microscopic disease, to be encompassed by CTV, cannot be visualised by any techniques developed to date and remain uncertain. As a result, the CTV is generally determined by clinicians based on their experience and patients' histopathological data. In this article we review histopathological studies addressing the extent of subclinical disease and its possible correlation with tumour characteristics in various tumour sites. The data have been tabulated to facilitate a comparison between proposed margins by different investigations and with current margins generally accepted for each tumour site. It is concluded that there is a need for further studies to reach a consensus on the optimal CTV pertaining to each tumour site.
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Affiliation(s)
- Leyla Moghaddasi
- Department of Medical Physics, Royal Adelaide Hospital, South Australia, 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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35
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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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Poortmans P, Aznar M, Bartelink H. Quality indicators for breast cancer: revisiting historical evidence in the context of technology changes. Semin Radiat Oncol 2012; 22:29-39. [PMID: 22177876 DOI: 10.1016/j.semradonc.2011.09.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Radiation therapy for breast cancer has considerably changed over the years, from simple simulator-based 2-dimensional techniques to sophisticated image-guided individualized treatments, with maximally protected normal structures. This has led to a substantial improvement in the outcome of breast cancer patients in terms of disease control, survival, and quality of life. This progress is based on clinical research and paralleled by progress in delivering sophisticated radiation treatment. Clinical trials resulted in identifying patients groups who will benefit from radiation treatment. They also stimulated the development of quality assurance tools and guidelines, which are now applied in daily clinical practice. The new technical opportunities to optimize dose distributions in patients require dedicated quality assurance measures because they may be more sensitive to variations throughout the treatment. Still, a large source of variation and uncertainty in radiation therapy remains in the definition of target volumes, which is clinically significant in terms of dosimetric target coverage as well as exposure of healthy tissues. This striving for continuous improvement of patient selection and treatment will lead to further improvement of local control while at the same time improving functional and cosmetic outcome and avoiding severe late complications, including cardiac toxicity.
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Affiliation(s)
- Philip Poortmans
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands.
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Thureau S, Oden S, Mokaouim R, Mezzani-Saillard S, Clatot F, Hanzen C. Évaluation de l’apport d’une méthode standardisée dans la définition du lit tumoral à l’aide de clips chirurgicaux dans le cancer du sein. Cancer Radiother 2012; 16:100-6. [PMID: 22310324 DOI: 10.1016/j.canrad.2011.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 09/16/2011] [Accepted: 10/03/2011] [Indexed: 11/30/2022]
Affiliation(s)
- S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, Rouen, France.
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Boersma LJ, Janssen T, Elkhuizen PHM, Poortmans P, van der Sangen M, Scholten AN, Hanbeukers B, Duppen JC, Hurkmans C, van Vliet C. Reducing interobserver variation of boost-CTV delineation in breast conserving radiation therapy using a pre-operative CT and delineation guidelines. Radiother Oncol 2012; 103:178-82. [PMID: 22265730 DOI: 10.1016/j.radonc.2011.12.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 12/09/2011] [Accepted: 12/19/2011] [Indexed: 11/17/2022]
Abstract
AIMS To investigate whether using a pre-operative CT scan (Preop-CT) (1) decreases interobserver variation of boost-CTV delineation in breast conserving therapy (BCT), and (2) influences the size of the delineated volumes. PATIENTS AND METHODS Thirty cT1-2N0-1 breast cancer patients underwent a CT-scan in radiation treatment position, prior to and after lumpectomy. Five observers delineated a boost-CTV, both with and without access to the Preop-CT. For each patient and for each observer pair, the conformity index (CI) and the distance between the centres of mass (COMd) for both boost volumes were calculated. In addition, all delineated volumes including the standard deviation (SD) with respect to the median delineation were calculated. RESULTS Using a Preop-CT reduced the mean COMd of the boost-CTV from 1.1cm to 1.0 cm (p<0.001). No effect was seen on the CI, but the boost-CTV volume reduced from 42 cc to 36 cc (p=0.005), implying a reduction of interobserver variation. We saw no significant change in the SD. CONCLUSION Use of a Preop-CT in BCT results in a modest but statistically significant reduction in interobserver variation of the boost-CTV delineations and in a significant reduction in the boost-CTV volume.
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Affiliation(s)
- Liesbeth J Boersma
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), The Netherlands.
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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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Haie-Meder C, Siebert FA, Pötter R. Image guided, adaptive, accelerated, high dose brachytherapy as model for advanced small volume radiotherapy. Radiother Oncol 2011; 100:333-43. [PMID: 21963284 DOI: 10.1016/j.radonc.2011.09.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 09/15/2011] [Indexed: 11/16/2022]
Abstract
Brachytherapy has consistently provided a very conformal radiation therapy modality. Over the last two decades this has been associated with significant improvements in imaging for brachytherapy applications (prostate, gynecology), resulting in many positive advances in treatment planning, application techniques and clinical outcome. This is emphasized by the increased use of brachytherapy in Europe with gynecology as continuous basis and prostate and breast as more recently growing fields. Image guidance enables exact knowledge of the applicator together with improved visualization of tumor and target volumes as well as of organs at risk providing the basis for very individualized 3D and 4D treatment planning. In this commentary the most important recent developments in prostate, gynecological and breast brachytherapy are reviewed, with a focus on European recent and current research aiming at the definition of areas for important future research. Moreover the positive impact of GEC-ESTRO recommendations and the highlights of brachytherapy physics are discussed what altogether presents a full overview of modern image guided brachytherapy. An overview is finally provided on past and current international brachytherapy publications focusing on "Radiotherapy and Oncology". These data show tremendous increase in almost all research areas over the last three decades strongly influenced recently by translational research in regard to imaging and technology. In order to provide high level clinical evidence for future brachytherapy practice the strong need for comprehensive prospective clinical research addressing brachytherapy issues is high-lighted.
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Localization of the surgical bed using supine magnetic resonance and computed tomography scan fusion for planification of breast interstitial brachytherapy. Radiother Oncol 2011; 100:480-4. [DOI: 10.1016/j.radonc.2011.08.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 11/24/2022]
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Boersma LJ, Hanbeukers B, Boetes C, Borger J, Ende PVD, Haaren EV, Houben R, Jager J, Murrer L, Sastrowijoto S, Baardwijk AV. Is contrast enhancement required to visualize a known breast tumor in a pre-operative CT scan? Radiother Oncol 2011; 100:271-5. [DOI: 10.1016/j.radonc.2011.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 06/11/2011] [Accepted: 06/11/2011] [Indexed: 10/18/2022]
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Barton SR, Smith IE, Kirby AM, Ashley S, Walsh G, Parton M. The role of ipsilateral breast radiotherapy in management of occult primary breast cancer presenting as axillary lymphadenopathy. Eur J Cancer 2011; 47:2099-106. [PMID: 21658935 DOI: 10.1016/j.ejca.2011.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 05/06/2011] [Indexed: 12/19/2022]
Abstract
AIM To assess the role of ipsilateral breast radiotherapy (IBR) in women with occult primary breast cancer presenting with axillary metastases (OPBC). METHODS Patients with axillary nodal metastases and histological diagnosis of breast cancer without palpable, mammographic or ultrasonographic evidence of a breast primary were identified from a prospectively maintained single institution database. Imaging, surgery, radiotherapy, recurrence and survival data were collected. Patients whose breast cancer primary was detected on MRI (but occult on clinical examination and other imaging) were excluded from the analyses of IBR and outcome, but were included in other exploratory analyses. RESULTS Fifty-five patients were included between 1975 and 2009. Median follow up was 68 months. Twenty patients had breast magnetic resonance imaging (MRI) in addition to other imaging. A primary breast cancer was detected in 7 of these 20. 48/55 patients had no detectable breast primary. 35/48 patients (73%) were treated with radiotherapy to the conserved breast, and 13/48 (27%) with observation. Patients who had IBR had better 5 year local recurrence free survival (LRFS) (84% versus 34%, p<0.001), and relapse free survival (RFS) (64% versus 34%, p=0.05), but no difference in overall survival (OS) (84% versus 85%, p=0.2). There was no difference in 5 year LRFS (80% versus 90%: p=0.3) between patients who received radiation of 50 Gy in 25 fractions versus ≥60 Gy. CONCLUSION Patients with OPBC should be managed with IBR and breast conservation, or mastectomy. Our data suggest it is not necessary to irradiate the breast to more than 50 Gy in 25 fractions.
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Affiliation(s)
- Sarah R Barton
- Breast Unit, The Royal Marsden Hospital and Institute of Cancer Research, Fulham Road, London SW36JJ, UK
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Evaluation of implanted gold seeds for breast radiotherapy planning and on treatment verification: a feasibility study on behalf of the IMPORT trialists. Radiother Oncol 2011; 100:276-81. [PMID: 21511352 DOI: 10.1016/j.radonc.2011.03.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 03/10/2011] [Accepted: 03/20/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE We describe a feasibility study testing the use of gold seeds for the identification of post-operative tumour bed after breast conservation surgery (BCS). MATERIALS AND METHODS Fifty-three patients undergoing BCS for invasive cancer were recruited. Successful use was defined as all six seeds correctly positioned around the tumour bed during BCS, unique identification of all implanted seeds on CT planning scan and ≥ 3 seeds uniquely identified at verification to give couch displacement co-ordinates in 10/15 fractions. Planning target volume (PTV) margin size for four correction strategies were calculated from these data. Variability in tumour bed contouring was investigated with five radiation oncologists outlining five CT datasets. RESULTS Success in inserting gold seeds, identifying them at CT planning and using them for on-treatment verification was recorded in 45/51 (88%), 37/38 (97%) and 42/43 (98%) of patients, respectively. The clinicians unfamiliar with CT breast planning consistently contoured larger volumes than those already trained. Margin size ranged from 10.1 to 1.4mm depending on correction strategy. CONCLUSION It is feasible to implant tumour bed gold seeds during BCS. Whilst taking longer to insert than surgical clips, they have the advantage of visibility for outlining and verification regardless of the ionising radiation beam quality. Appropriate correction strategies enable margins of the order of 5mm as required by the IMPORT trials however, tackling clinician variability in contouring is important.
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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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Precise correlation between MRI and histopathology - exploring treatment margins for MRI-guided localized breast cancer therapy. Radiother Oncol 2010; 97:225-32. [PMID: 20826026 DOI: 10.1016/j.radonc.2010.07.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/04/2010] [Accepted: 07/18/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is more often considered to guide, evaluate or select patients for partial breast irradiation (PBI) or minimally invasive therapy. Safe treatment margins around the MRI-visible lesion (MRI-GTV) are needed to account for surrounding subclinical occult disease. PURPOSE To precisely compare MRI findings with histopathology, and to obtain detailed knowledge about type, rate, quantity and distance of occult disease around the MRI-GTV. METHODS AND MATERIALS Patients undergoing MRI and breast-conserving therapy were prospectively included. The wide local excision specimens were subjected to detailed microscopic examination. The size of the invasive (index) tumor was compared with the MRI-GTV. The gross tumor volume (GTV) was defined as the pre-treatment visible lesion. Subclinical tumor foci were reconstructed at various distances to the MRI-GTV. RESULTS Sixty-two patients (64 breasts) were included. The mean size difference between MRI-GTV and the index tumor was 1.3mm. Subclinical disease occurred in 52% and 25% of the specimens at distances ≥10mm and ≥20mm, respectively, from the MRI-GTV. CONCLUSIONS For MRI-guided minimally invasive therapy, typical treatment margins of 10mm around the MRI-GTV may include occult disease in 52% of patients. When surgery achieves a 10mm tumor-free margin around the MRI-GTV, radiotherapy to the tumor bed may require clinical target volume margins >10mm in up to one-fourth of the patients.
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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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Toscas JI, Linero D, Rubio I, Hidalgo A, Arnalte R, Escudé L, Cozzi L, Fogliata A, Miralbell R. Boosting the tumor bed from deep-seated tumors in early-stage breast cancer: a planning study between electron, photon, and proton beams. Radiother Oncol 2010; 96:192-8. [PMID: 20538361 DOI: 10.1016/j.radonc.2010.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 05/14/2010] [Accepted: 05/14/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the potential dosimetric advantages and drawbacks of photon beams (modulated or not), electron beams (EB), and protons as a boost for the tumor bed in deep-seated early-stage breast cancer. MATERIAL AND METHODS Planning CTs of 14 women with deep-seated tumors (i.e., > or =4 cm depth) were selected. The clinical target volume (CTV) was defined as the area of architectural distortion surrounded by surgical clips. The planning treatment volume (PTV) was the CTV plus 1cm margin. A dose of 16 Gy in 2 Gy fractions was prescribed. Organs at risk (OARs) were heart, lungs, breasts, and a 5-mm thick skin segment on the breast surface. Dose-volume metrics were defined to quantify the quality of concurrent treatment plans assessing target coverage and sparing of OAR. The following treatment techniques were assessed: photon beams with either static 3D-conformal, dynamic arc (DCA), static gantry intensity-modulated beams (IMRT), or RapidArc (RA); a single conformal EB; and intensity-modulated proton beams (IMPT). The goal for this planning effort was to cover 100% of the CTV with 95% of the prescribed dose and to minimize the volume inside the CTV receiving >107% of the dose. RESULTS All techniques but DCA and EB achieved the planning objective for the CTV with an inhomogeneity ranging from 2% to 11%. RA showed the best conformity, EB the worst. Contra-lateral breast and lung were spared by all techniques with mean doses <0.5 Gy (zero for protons). The ipsi-lateral lung received a mean dose <10% of that prescribed with photon beams and <2% with IMPT, increasing to 17% with EB. The heart, in left-sided breast tumors, received also the highest dose with EB. The skin was best protected with RA with a mean dose of 5.4 Gy and V(15Gy)=2.4%. CONCLUSIONS Boosting the tumor bed in early-stage breast cancer with optimized photon or proton beams may be preferred to EB especially for deep-seated targets. The marked OAR (i.e., ipsi-lateral breast, lung, heart, and skin surface) dose-sparing effect may allow for a potential long-term toxicity risk reduction and better cosmesis. DCA or RA may also be considered alternative treatment options for patients eligible for accelerated partial breast irradiation trials.
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