Ongoing clinical experience utilizing 3D conformal external beam radiotherapy to deliver partial-breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy

Vicini, Frank A.; Remouchamps, Vincent; Wallace, Michelle; Sharpe, Michael B.; Fayad, Julie; Tyburski, L.; Letts, Nicola; Kestin, Larry L.; Edmundson, Gregory K.; Pettinga, Jane; Goldstein, Neal S.; Wong, John W.

doi:10.1016/s0360-3016(03)01573-6

Cited by 210 publications

(76 citation statements)

References 24 publications

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“…The RoC before RT was found to be higher in patients with a larger

{CTV}_{LC}

prior to starting RT, whereas

{CTV}_{LC}

volume did not affect the RoC during RT. A comparison of this study with select previous studies ( 2 , 5 , 7 – 19 ) is presented in Table 4.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of the studies of postsurgical LC variations compared volumes of a baseline

{CTV}_{LC}

contoured on

{CT}_{sim}

with LC volume contoured on one CT acquired during RT ( 7 – 9 , 11 , 12 , 14 – 17 ) at varying time points in a retrospective fashion. In this study, as patients were entered prospectively, time points of CBCT measurement were performed consistently between patients.…”

Section: Discussionmentioning

confidence: 99%

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Cone‐beam computed tomography image guided therapy to evaluate lumpectomy cavity variation before and during breast radiotherapy

Truong

Hirsch

Kovalchuk

et al. 2013

J Applied Clin Med Phys

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The purpose of this study was to evaluate the rate of change (RoC) in the size of the lumpectomy cavity (LC) before and during breast radiotherapy (RT) using cone‐beam computed tomography (CBCT), relative to the initial LC volume at CT simulation (CTVLC) and timing from surgery. A prospective institutional review board‐approved study included 26 patients undergoing breast RT: 20 whole breast irradiation (WBI) patients and six partial breast irradiation (PBI) patients, with surgical clips outlining the LC. The patients underwent CT simulation (CTsim) followed by five CBCTs during RT, once daily for PBI and once weekly for WBI. The distance between surgical clips and their centroid (D) acted as a surrogate for LC size. The RoC of the LC size, defined as the percentage change of D between two scans divided by the time interval in days between the scans, was calculated before (CTsim to CBCT1) and during RT (CBCT1 to CBCT5). The mean RoC of D for all patients before starting RT was −0.25%/day (range, −1.3 to 1.4) and for WBI patients during RT was −0.15%/day (range, −0.45 to 0.40). Stratified by median CTVLC, the RoC before RT for large CTVLC group (≥25.7cc) was 15 times higher (−0.47%/day) than for small CTVLC group (<25.7 cc) (−0.03%/day), p=0.06. For patients undergoing CTsim < 42 days from surgery, the RoC before RT was −0.43%/day compared to −0.07%/day for patients undergoing CTsim≥42 days from surgery, p=0.12. For breast cancer RT, the rate of change of the LC is affected by the initial cavity size and the timing from surgery. Resimulation closer to the time of boost treatment should be considered in patients who are initially simulated within six weeks of surgery and/or with large CTVLC.PACS number: 87.55.de

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“…The RoC before RT was found to be higher in patients with a larger

{CTV}_{LC}

prior to starting RT, whereas

{CTV}_{LC}

volume did not affect the RoC during RT. A comparison of this study with select previous studies ( 2 , 5 , 7 – 19 ) is presented in Table 4.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of the studies of postsurgical LC variations compared volumes of a baseline

{CTV}_{LC}

contoured on

{CT}_{sim}

Section: Discussionmentioning

confidence: 99%

Cone‐beam computed tomography image guided therapy to evaluate lumpectomy cavity variation before and during breast radiotherapy

Truong

Hirsch

Kovalchuk

et al. 2013

J Applied Clin Med Phys

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“…Several preliminary studies have demonstrated the feasibility of delivering PBI using external beam threedimensional conformal radiotherapy [6][7][8] .The feasibility depends significantly on the ratio between evaluation planning target volume (PTV_eval) and the whole breast volume, V whole breast ("PBI volume ratio", abbreviated as PVR) 9 :…”

Section: Introductionmentioning

confidence: 99%

“…The fraction size commonly used in external beam accelerated PBI is 3.85 Gy 6,7,9 . Therefore, the dose constraints for normal tissues are typically stringent to minimise the risk of radiation toxicity.…”

Section: Introductionmentioning

confidence: 99%

“…Vicini et al reported that PBI is feasible in terms of normal tissue dose constraints only if the PVR is 0.25 or less 9 . Therefore, it would be useful if one could determine the PVR for individual patients as early as possible in their radiotherapy management in order to avoid consenting patients to a treatment for which they may not be eligible and reducing the workload associated with the increased outlining necessary for PBI.…”

Section: Introductionmentioning

confidence: 99%

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A spreadsheet to determine the volume ratio for target and breast in partial breast irradiation*

Kron

Willis

Miller

et al. 2009

Australas. Phys. Eng. Sci. Med.

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The technical feasibility of Partial Breast Irradiation (PBI) using external beam radiotherapy depends on the ratio between the evaluation planning target volume (PTV_eval) and the whole breast volume ("PBI volume ratio" = PVR). We aimed to develop a simple method to determine PVR using measurements performed at the time of the planning CT scan. A PVR calculation tool was developed using a Microsoft Excel spreadsheet to determine the PTV from three orthogonal dimensions of the seroma cavity and a given margin on the CT scans. The breast volume is estimated from the separation and breast height in five equally spaced CT slices. The PTV_eval and whole breast volume were determined for 29 patients from two centres using the spreadsheet calculation tool and compared to volumes delineated on computerised treatment planning systems. Both the PTV_eval and whole breast volumes were underestimated by approximately 25% using the spreadsheet. The resulting PVRs were 1.05 +/- 0.35 (mean +/- 1SD) times larger than the ones determined from planning. Estimations of the PVR using the calculation tool were achievable in around 5 minutes at the time of CT scanning and allow a prompt decision on the suitability of the patients for PBI.

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Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

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Mastectomy is the current standard of care for in-breast local recurrence of breast carcinoma. The objective of the current study was to critically review the rationale for and the theoretic and actual risks and benefits of repeat breast-conserving surgery followed by partial breast irradiation (PBI) for in-breast local recurrence of breast carcinoma. The main outcomes of interest were local control and survival after in-breast local recurrence and side effects, complications, and cosmesis after reirradiation of the breast. The risk of local recurrence was not found to be eliminated with mastectomy; approximately 2-32% of patients treated with mastectomy develop a chest wall recurrence. The interpretation of local control rates in evaluating repeat breast-conserving surgery studies is difficult because of the lack of information regarding preoperative diagnostic mammography to rule out concurrent multicentric disease and microscopic margin status after surgery. Rates of subsequent local recurrence in these studies appeared to be between 19 -50%, similar to reported rates of in-breast local recurrence in patients with a first diagnosis of breast carcinoma who were treated with conservative surgery without irradiation. Early follow-up studies of breast reirradiation suggest that catheterbased interstitial brachytherapy and standard external beam radiation therapy can be delivered to the breast more than once without significant side effects in most patients and with acceptable cosmesis in some patients. Mastectomy may not be necessary in all patients with an in-breast local recurrence of breast carcinoma. KEYWORDS: recurrent breast carcinoma, breast surgery, radiation therapy, accelerated partial breast irradiation, three-dimensional conformal radiation therapy, brachytherapy.A t present, the standard surgical approach for the treatment of in-breast local recurrence of breast carcinoma is mastectomy. The rationale for the general consensus for this recommendation is threefold. First, a third local recurrence after repeat conservative surgery is reported in approximately 35% of patients. Second, a second lumpectomy would yield a cosmetically unacceptable outcome. Third, reirradiation of the whole breast after breast-conserving surgery is considered inappropriate because of the likelihood of serious tissue damage. Recently, novel brachytherapy devices and three-dimensional conformal radiation therapy techniques have brought accelerated partial breast irradiation (APBI) to the forefront as a potential treatment approach in women with in-breast local recurrence of 2269

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Ongoing clinical experience utilizing 3D conformal external beam radiotherapy to deliver partial-breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy

Cited by 210 publications

References 24 publications

Cone‐beam computed tomography image guided therapy to evaluate lumpectomy cavity variation before and during breast radiotherapy

Cone‐beam computed tomography image guided therapy to evaluate lumpectomy cavity variation before and during breast radiotherapy

A spreadsheet to determine the volume ratio for target and breast in partial breast irradiation*

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

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