Computer-CT planning of the electron boost om definitive breast irradiation

Regine, William F.; Ayyangar, Komanduri M.; Komarnicky, Lydia; Bhandare, Niranjan; Mansfield, Carl M.

doi:10.1016/0360-3016(91)90147-v

Cited by 75 publications

(8 citation statements)

References 9 publications

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“…From 10 to 67% of scar based boost plans were inaccurate in defining the boost volume when compared with surgical clip based plans [15-17]. And 70 to 80% of scar based plans resulted in geographical misses or modifications when compared with CT based plans [18-20]. CT based planning has become more popular in practice over the last several years and could reduce the geographical misses [21].…”

Section: Discussionmentioning

confidence: 99%

Volumetric changes in the lumpectomy cavity during whole breast irradiation after breast conserving surgery

Cho

Kim

2011

Radiat Oncol J

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PurposeThis 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 MethodsFrom 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.ResultsThe 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).ConclusionThe 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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Section: Discussionmentioning

confidence: 99%

Volumetric changes in the lumpectomy cavity during whole breast irradiation after breast conserving surgery

Cho

Kim

2011

Radiat Oncol J

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“…Boost options include interstitial brachytherapy (BT), electron or photon therapy, all following or preceding whole breast radiotherapy (WBRT) using external beam [1, 3, 4, 5, 6, 7]. In all above approaches, the extent of boost tumor volume may be incorrect if the tumor bed is determined using clinical parameters (e.g., palpation, pre-operative mammography, scar position, operative and pathology reports, or surgical clips placed at the excision site boundaries) [8, 9, 10]. The direct visualization of the operative site during surgery allows for decreasing the risk of “geographical miss” in determining the target volume.…”

Section: Purposementioning

confidence: 99%

Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer

Serkies

Jaśkiewicz

Dziadziuszko

et al. 2016

jcb

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PurposeTo evaluate peri-operative multicatheter interstitial pulsed-dose-rate brachytherapy (PDR-BT) with an intra-operative catheter placement to boost the tumor excision site in breast cancer patients treated conservatively.Material and methodsBetween May 2002 and October 2008, 96 consecutive T1-3N0-2M0 breast cancer patients underwent breast-conserving therapy (BCT) including peri-operative PDR-BT boost, followed by whole breast external beam radiotherapy (WBRT). The BT dose of 15 Gy (1 Gy/pulse/h) was given on the following day after surgery.ResultsNo increased bleeding or delayed wound healing related to the implants were observed. The only side effects included one case of temporary peri-operative breast infection and 3 cases of fat necrosis, both early and late. In 11 patients (11.4%), subsequent WBRT was omitted owing to the final pathology findings. These included eight patients who underwent mastectomy due to multiple adverse prognostic pathological features, one case of lobular carcinoma in situ, and two cases with no malignant tumor. With a median follow-up of 12 years (range: 7-14 years), among 85 patients who completed BCT, there was one ipsilateral breast tumor and one locoregional nodal recurrence. Six patients developed distant metastases and one was diagnosed with angiosarcoma within irradiated breast. The actuarial 5- and 10-year disease free survival was 90% (95% CI: 84-96%) and 87% (95% CI: 80-94%), respectively, for the patients with invasive breast cancer, and 91% (95% CI: 84-97%) and 89% (95% CI: 82-96%), respectively, for patients who completed BCT. Good cosmetic outcome by self-assessment was achieved in 58 out of 64 (91%) evaluable patients.ConclusionsPeri-operative PDR-BT boost with intra-operative tube placement followed by EBRT is feasible and devoid of considerable toxicity, and provides excellent long-term local control. However, this strategy necessitates careful patient selection and histological confirmation of primary diagnosis.

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“…[4][5][6] The importance of the use of surgical clips and CT scan for the definition of the tumour bed was already reported more than 15 years ago. 7,8 CT-based RT planning is now widely adopted, and its use has become more common for boost volume definition. [9][10][11] Recently, it was shown that the use of CT-based volume delineation and treatment planning involves a larger irradiated boost volume, which could increase the risk of side effects.…”

Section: Introductionmentioning

confidence: 99%

“…7,8,[43][44][45] However, surgical clips are not always placed at the time of surgery and hence may not be available to assist in target volume delineation.…”

mentioning

confidence: 99%

Comparison of two radiation techniques for the breast boost in patients undergoing neoadjuvant treatment for breast cancer

Santis

Nardone

Diletto

et al. 2016

BJR

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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 (D 95 ), the minimal dose received by 90% of the target volume (D 90 ) 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 D 95 of 96.3% (range 94.7-99.6%) and 0.8% (range 0-30%) and a median D 90 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 D 90 and median D 95 , 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 D max . Conclusion: Our data show that an anticipated preoperative 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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Computer-CT planning of the electron boost om definitive breast irradiation

Cited by 75 publications

References 9 publications

Volumetric changes in the lumpectomy cavity during whole breast irradiation after breast conserving surgery

Volumetric changes in the lumpectomy cavity during whole breast irradiation after breast conserving surgery

Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer

Comparison of two radiation techniques for the breast boost in patients undergoing neoadjuvant treatment for breast cancer

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