Surgical clips in planning the electron boost in breast cancer: A qualitative and quantitative evaluation

Harrington, Kevin J.; Harrison, Mark; Bayle, Patricia; Evans, Kieran; Dunn, P.; Lambert, H. E.; Saidan, Zuhair; Lynn, John A.; Stewart, J.S.W.

doi:10.1016/0360-3016(95)02090-x

Cited by 118 publications

(65 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients with a high risk of recurrence receive a radiotherapy boost dose to the tumour bed (TB) [1]. Whilst clinical localisation and treatment with electron is common, accurate localisation of the tumour bed is achieved only if internal markers are used to indicate its position on computed tomography (CT) images [2,3]. This improved localisation enables conformal photon dose distributions to be created which deliver the boost dose to the tumour bed whilst ensuring the dose to other tissues is not excessive.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Image Guidance on Dose Distributions in Breast Boost Radiotherapy

et al. 2014

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

The Effect of Image Guidance on Dose Distributions in Breast Boost Radiotherapy

et al. 2014

View full text Add to dashboard Cite

“…Until recently, TB localization was performed using pre-operative radiological imaging, surgical annotation, clinical palpation of surgical defect, scar position and patient recollection of tumour location. Nowadays, localisation of titanium clips attached to excision cavity walls at surgery reduce the risks of geographical miss and unnecessary normaltissue irradiation (6)(7)(8)(9). Clips provide additional localization information compared to kv-CTimaging alone, leading to modification of field borders in 43% of patients (10).…”

Section: Introductionmentioning

confidence: 99%

Tumor Bed Delineation for Partial Breast and Breast Boost Radiotherapy Planned in the Prone Position: What Does MRI Add to X-ray CT Localization of Titanium Clips Placed in the Excision Cavity Wall?

Kirby

Yarnold

Evans

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

“…As part of their radiotherapy, patients at high risk of recurrence receive a boost dose to the region around the tumour bed 110 . Evidence shows that accurate localisation of the tumour bed can only be achieved if internal markers are used to indicate its position on imaging, particularly CT images 111,112 . This approach to improve localisation allows conformal photon dose distributions to be used to deliver the tumour bed boost dose whilst minimising dose to normal tissues.…”

Section: Introductionmentioning

confidence: 99%

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Harris

Mukesh

Jena

et al. 2014

Efficacy and Mechanism Evaluation

View full text Add to dashboard Cite

Background Whole-breast radiotherapy (WBRT) is the standard treatment for breast cancer following breast-conserving surgery. Evidence shows that tumour recurrences occur near the original cancer: the tumour bed. New treatment developments include increasing dose to the tumour bed during WBRT (synchronous integrated boost) and irradiating only the region around the tumour bed, for patients at high and low risk of tumour recurrence, respectively. Currently, standard imaging uses bony anatomy to ensure accurate delivery of WBRT. It is debatable whether or not more targeted treatments such as synchronous integrated boost and partial-breast radiotherapy require image-guided radiotherapy (IGRT) focusing on implanted tumour bed clips (clip-based IGRT). Objectives Primary – to compare accuracy of patient set-up using standard imaging compared with clip-based IGRT. Secondary – comparison of imaging techniques using (1) tumour bed radiotherapy safety margins, (2) volume of breast tissue irradiated around tumour bed, (3) estimated breast toxicity following development of a normal tissue control probability model and (4) time taken. Design Multicentre observational study embedded within a national randomised trial: IMPORT-HIGH (Intensity Modulated and Partial Organ Radiotherapy – HIGHer-risk patient group) testing synchronous integrated boost and using clip-based IGRT. Setting Five radiotherapy departments, participating in IMPORT-HIGH. Participants Two-hundred and eighteen patients receiving breast radiotherapy within IMPORT-HIGH. Interventions There was no direct intervention in patients’ treatment. Experimental and control intervention were clip-based IGRT and standard imaging, respectively. IMPORT-HIGH patients received clip-based IGRT as routine; standard imaging data were obtained from clip-based IGRT images. Main outcome measures Difference in (1) set-up errors, (2) safety margins, (3) volume of breast tissue irradiated, (4) breast toxicity and (5) time, between clip-based IGRT and standard imaging. Results The primary outcome of overall mean difference in clip-based IGRT and standard imaging using daily set-up errors was 2–2.6 mm (p < 0.001). Heterogeneity testing between centres found a statistically significant difference in set-up errors at one centre. For four centres (179 patients), clip-based IGRT gave a mean decrease in the systematic set-up error of between 1 mm and 2 mm compared with standard imaging. Secondary outcomes were as follows: clip-based IGRT and standard imaging safety margins were less than 5 mm and 8 mm, respectively. Using clip-based IGRT, the median volume of tissue receiving 95% of prescribed boost dose decreased by 29 cm3 (range 11–193 cm3) compared with standard imaging. Difference in median time required to perform clip-based IGRT compared with standard imaging was X-ray imaging technique dependent (range 8–76 seconds). It was not possible to estimate differences in breast toxicity, the normal tissue control probability model indicated that for breast fibrosis maximum radiotherapy dose is ...

show abstract

Surgical clips in planning the electron boost in breast cancer: A qualitative and quantitative evaluation

Cited by 118 publications

References 14 publications

The Effect of Image Guidance on Dose Distributions in Breast Boost Radiotherapy

The Effect of Image Guidance on Dose Distributions in Breast Boost Radiotherapy

Tumor Bed Delineation for Partial Breast and Breast Boost Radiotherapy Planned in the Prone Position: What Does MRI Add to X-ray CT Localization of Titanium Clips Placed in the Excision Cavity Wall?

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Contact Info

Product

Resources

About