Titanium clip placement to allow accurate tumour bed localisation following breast conserving surgery – audit on behalf of the IMPORT Trial Management Group

Coles, C.E.; Wishart, Gabrielle; Cumming, Joseph; Benson, Jay; Forouhi, Parto; Wilson, Christopher; Wilkinson, Jared; Sharma, Raj; Yarnold, J.

doi:10.1016/s1359-6349(08)70642-6

Cited by 16 publications

(24 citation statements)

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“…All women had undergone BCS for unifocal T1-2 G1-3 invasive-ductal carcinoma or high-grade ductal-carcinoma-in-situ, at which time titanium-clips were placed in the tumour-bed (TB) according to a UK protocol (17).…”

Section: Methodsmentioning

confidence: 99%

Prone versus supine positioning for whole and partial-breast radiotherapy: A comparison of non-target tissue dosimetry

Kirby

Evans

Donovan

et al. 2010

Radiotherapy and Oncology

151

133

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Section: Methodsmentioning

confidence: 99%

Prone versus supine positioning for whole and partial-breast radiotherapy: A comparison of non-target tissue dosimetry

Kirby

Evans

Donovan

et al. 2010

Radiotherapy and Oncology

151

133

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“…Eligible patients were recruited via an ethically-approved study in which wide local excision of invasive ductal carcinoma of the breast was followed by placement of six titanium clips according to a national protocol (17), one at each of the four radial, the deep and the superficial excision margins. All patients had undergone full-thickness closure of the tumour cavity.…”

Section: Eligibilitymentioning

confidence: 99%

“…Markers implanted in surgical cavity walls provide additional localization information compared to kV-CT-imaging alone (13), such that CT and marker-based TB delineation has been recommended as the current gold standard (14). Despite this, the use of implanted fiducial markers is still not widespread.…”

Section: Introductionmentioning

confidence: 99%

“…A UK protocol recommends that paired clips be inserted into the four radial, the deep and the superficial margins of excision Tumour bed markers Kirby page 5 (16) but, having established that clips do not migrate, more recent studies recommend placement of six markers (four radial, a chest wall and a superficial marker) (17). Many surgeons however prefer not to place a superficial clip due to concerns over marker mobility, cosmesis and marker palpability.…”

Section: Introductionmentioning

confidence: 99%

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Tumour bed delineation for partial breast/breast boost radiotherapy: What is the optimal number of implanted markers?

Kirby

Jena

Harris

et al. 2013

Radiotherapy and Oncology

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“…Pilot work was undertaken in preparation for the IMPORT HIGH trial and as a consequence clips are now recommended for all patients undergoing breast conservation surgery by the British Association of Surgical Oncology 5 . The key advantage of this approach is that surgical clips can be visualised directly using the low energy x-ray facility on the treatment machine.…”

Section: Structure Of This Reportmentioning

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

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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 ...

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Titanium clip placement to allow accurate tumour bed localisation following breast conserving surgery – audit on behalf of the IMPORT Trial Management Group

Cited by 16 publications

References 0 publications

Prone versus supine positioning for whole and partial-breast radiotherapy: A comparison of non-target tissue dosimetry

Prone versus supine positioning for whole and partial-breast radiotherapy: A comparison of non-target tissue dosimetry

Tumour bed delineation for partial breast/breast boost radiotherapy: What is the optimal number of implanted markers?

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

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