Injection of radiopaque hydrogel at time of lumpectomy improves the target definition for adjuvant radiotherapy

Struik, Gerson M.; Hoekstra, Nienke; Klem, T.M.A.L.; Ghandi, Ali; Verduijn, Gerda M.; Swaak-Kragten, Annemarie; Schoonbeek, Alja; Vries, Kim C. de; Sattler, Margriet A.; Verhoef, Kees; Birnie, Erwin; Pignol, Jean-Philippe

doi:10.1016/j.radonc.2018.11.003

Cited by 12 publications

(9 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of iodinated PEG injected into the surgical cavity has been shown to improve the interobserver agreement in breast radiotherapy target definition, however there were issues with dilution due to seroma formation [23] . HA gels have been used as spacers in radiotherapy [22] and have recently been studied as a tumour bed marker in BCS [24] .…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, injectable hydrogels have been used as spacers to separate critical structures from high dose areas, such as in prostate radiotherapy to spare the rectum [22] . Struik et al [23] showed that iodinated polyethylene glycol (PEG) injected at the time of lumpectomy resulted in high inter-observer agreement of APBI target definition. This iodinated PEG was well visible with CT, but not with planar kilovoltage (kV) imaging.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of visibility of iodinated hydrogel and gadolinium-modified hyaluronic acid spacer gels on computed tomography and onboard imaging

Riberdy

Ruiz

Hoekstra

et al. 2022

Physics and Imaging in Radiation Oncology

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of visibility of iodinated hydrogel and gadolinium-modified hyaluronic acid spacer gels on computed tomography and onboard imaging

Riberdy

Ruiz

Hoekstra

et al. 2022

Physics and Imaging in Radiation Oncology

Self Cite

View full text Add to dashboard Cite

“…Several studies have investigated fiducial placement within the tumor cavity at the time of OPM in order to aid in boost delineation at the time of radiotherapy, and results have shown that clip location can be outside the original tumor quadrant in up to 50% of cases, presumably as a result of the rotations and closures that are inherent in this technique [ 16 , 17 ]. Several other localization devices, such as radio-opaque gels and films, have also been investigated as intra-operative markers to aid in future radiation boost planning [ 19 , 20 ]. Consequently, there have been calls for increased collaboration and a multi-disciplinary approach to patient selection for treatment planning in OPM cases [ 10 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Implications of Oncoplastic Breast Surgery on Radiation Boost Delivery in Localized Breast Cancer

Gladwish¹,

DiDiodato²,

Conway³

et al. 2021

Cureus

View full text Add to dashboard Cite

BackgroundOncoplastic partial mastectomy (OPM) is a technique utilized to improve aesthetic and survivorship outcomes in patients with localized breast cancer. This technique leads to breast tissue rearrangement, which can have an impact on target definition for boost radiotherapy (BRT). The aim of this study was to determine if the choice of surgical technique independently affected the decision to deliver a radiation boost. Materials and methodsThis was a retrospective study of patients treated between January 2017 and December 2018. We selected consecutive patients based on surgical procedure: 50 undergoing standard breast-conserving surgery and 50 having had an OPM. The primary outcome was average treatment effect (ATE) of surgery type on reception of BRT. Secondary outcomes included ATE of surgery type on the time to reception of radiotherapy and incidence of ipsilateral breast tumor recurrence (IBTR). The ratio of boost clinical target volume (CTV) to pathologic tumor size was also compared between the two groups. Treatment effects regression adjustment and inverse-probability weighted analysis was used to estimate ATEs for both primary and secondary outcomes. ResultsFor the entire cohort, the median age was 64 years (range: 37-88 years). The median tumor size was 1.5 cm (range: 0.1-6.5 cm). The majority of patients were with ≤ stage IIA (78%), invasive ductal subtype (80%), negative lymphovascular space invasion (78%), negative margin (90%), and positive ER/PR (estrogen receptor/progesterone receptor) (69%). Overall, surgical technique was not associated with differences in the proportion of patients receiving BRT (ATE: 6.0% [95% CI: -4.5 to 16.0]). There were no differences in delays to radiation treatment between the two groups (ATE: 32.8 days [95% CI: -22.1 to 87.7]). With a median follow-up time of 419 days (range: 30-793 days), there were only five recurrences, with one case of IBTR in each group. There was no difference in the ratio of CTV volume to tumor size between the two groups (p=0.38). ConclusionsOPM did not affect the decision to offer localized BRT following standard whole breast radiotherapy or significantly affect treatment times or radiation volumes. The decision to offer OPM should include a multidisciplinary approach.

show abstract

“…Several studies have investigated ducial placement within the tumor cavity at the time of OPM in order to aid in boost delineation at the time of radiotherapy, and results have shown that clip location can be outside the original tumor quadrant in up to 50% of cases [16,17]. Several other localization devices, such as radioopaque gels and lms, have also been investigated as intra-operative markers to aid in future radiation boost planning [19,20]. Consequently there have been calls for increased collaboration and a multidisciplinary approach to patient selection for treatment planning in OPM cases [10,21].…”

Section: Discussionmentioning

confidence: 99%

Implications of Oncoplastic Breast Surgery on Radiation Boost Delivery in Localized Breast Cancer

Gladwish

Sauve²,

DiDiodato³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background:Oncoplastic partial mastectomy (OPM) is a technique utilized to improve aesthetic and survivorship outcomesin patients with localized breast cancer. This technique leads to breast tissue rearrangement, which can have an impact on target definition for boost radiotherapy (BRT). The aim of this study was to determine if the choice of surgical technique independently affected the decision to deliver a radiation boost.Materials and Methods: This was a retrospective study of patients treated between January 2017 and December 2018. We selected consecutive patients based on surgical procedure; 50 undergoing standard breast conserving surgery and 50 having had an OPM. The primary outcome was average treatment effect (ATE) of surgery type on reception of BRT, accounting for patient age, tumor grade, lymphovascular space invasion, margin status and ER status as potential confounding variables. Secondary outcomes included ATE of surgery type on the time to reception of radiotherapy and incidence of ipsilateral breast tumor recurrence (IBTR). The ratio of boost seroma volume to pathologic tumor size was also compared between the two groups. Treatment effects regression adjustment and inverse-probability weighted analysis was used to estimate ATEs for both primary and secondary outcomes.Results: Median age was 64 years (range 37 – 88). The median tumor size was 1.5 cm (range 0.1 – 6.5). The majority of patients were ≤ stage IIA (78%), invasive ductal subtype (80%), LVSI negative (78%), margin negative (90%) and ER/PR +ve (69%). Overall, surgical technique was not associated with differences in the proportion of patients receiving BRT (ATE 6.0% (95% CI -4.5, 16.0)). There were no differences in delays to radiation treatment between the two groups (ATE 32.8 days (95% CI -22.1, 87.7)). With a median follow-up time of 419 days (range 30 – 793), there were only 5 recurrences, with 1 case of IBTR in each group. There was no difference in the ratio of seroma volume to tumor size between the two groups (p=0.38).Conclusions: OPM did not affect the decision to offer localized BRT following standard whole breast radiotherapy, or significantly affect treatment times or radiation volumes. The decision to offer OPM should include a multi-disciplinary approach.

show abstract

Injection of radiopaque hydrogel at time of lumpectomy improves the target definition for adjuvant radiotherapy

Cited by 12 publications

References 38 publications

Comparison of visibility of iodinated hydrogel and gadolinium-modified hyaluronic acid spacer gels on computed tomography and onboard imaging

Comparison of visibility of iodinated hydrogel and gadolinium-modified hyaluronic acid spacer gels on computed tomography and onboard imaging

Implications of Oncoplastic Breast Surgery on Radiation Boost Delivery in Localized Breast Cancer

Implications of Oncoplastic Breast Surgery on Radiation Boost Delivery in Localized Breast Cancer

Contact Info

Product

Resources

About