Planning the breast boost: How accurately do surgical clips represent the CT seroma?

Yang, Zhaozhi; Chen, Jiayi; Hu, Wenyu; Pan, Ziqiang; Cai, Gang; Yu, Xiaoli; Xin, Mei; Zhang, Qian; Liu, Taifu; Guo, Xiaomao

doi:10.1016/j.radonc.2010.09.007

Cited by 48 publications

(33 citation statements)

References 28 publications

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“…The interobserver concordance (VOI) for the patients with (≥4 clips) and without clips denoting SC boundaries was in agreement for all datasets except CT supine, where average conformity for those without clips was higher. This may be because clips are not always consistent with the SC walls [10], can migrate significantly over days/weeks postoperatively [35] and are larger than CT and US defined volumes [11].…”

Section: Discussionmentioning

confidence: 99%

“…Small observer studies have shown conflicting results, with the SCs proven to be both smaller (with less inter-observer variation from 3 observers, [7]) and larger (one observer, [8]) on MRI than CT. Clips provide another option [9], however these are not always consistent with the SC walls [10], can migrate and are larger than CT and US defined volumes [11].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Magnetic Resonance Imaging and Computed Tomography for Breast Target Volume Delineation in Prone and Supine Positions

Pogson

Delaney

Ahern

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose/Objective(s): MRI provides no ionizing radiation dose (allowing inter and intra fraction imaging), improved soft tissue contrast and potentially improved conformity in delineation than CT. This study aimed to determine if T2 weighted magnetic resonance imaging improves seroma cavity (SC) and Whole Breast (WB) inter-observer conformity for radiotherapy purposes compared with the gold standard of CT, both in the prone and supine positions. Results: Imaging modality did not affect inter-observer variation for WB CTVs. Prone WB CTVs were larger in volume and more conformal than Supine CTVs (on both MRI and CT). SC volumes were larger on CT than MRI. SC volumes proved to be comparable in inter-observer conformity in both modalities (VOI of 0.57±0.03 for CT supine, 0.52±0.04 for MR supine, 0.56±0.03 for CT prone and 0.55±0.04 for MR prone) however after registering modalities together the inter-modality variation (DSC of 0.41±0.05 for supine and 0.38±0.04 for prone) was larger than the inter-observer variability for SC despite the location typically remaining constant.Conclusions: MRI inter-observer variation was comparable to CT for the WB CTV and SC delineation, in both prone and supine positions. Whilst the CVS and inter-observer concordance M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 3 was not significantly higher for MRI than CT, the SCs were smaller on MRI, potentially due to clearer SC definition, especially on T2-weighted MR images.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Magnetic Resonance Imaging and Computed Tomography for Breast Target Volume Delineation in Prone and Supine Positions

Pogson

Delaney

Ahern

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…Postoperative seroma edges and corresponding clips do not always match well. Seroma edges extend beyond clips by an average of 3-5 mm and nearly a quarter of the margines have a gap between clips and seroma edges exceeding 5 mm [15]. This uncertainity causes significant interobserver variability in the delineation of the clinical target volume (CTV) for boost even among radiation oncologists who specialize in breast radiotherapy [16].…”

Section: Discussionmentioning

confidence: 99%

Perioperative interstitial CT-based brachytherapy boost in breast cancer patients with breast conservation after neoadjuvant chemotherapy

Doležel¹,

Šťastný²,

Odrážka³

et al. 2012

neo

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Intraoperative placement of catheters in the tumor bed during breast-conserving surgery (BCS) enables postponed targeted boost irradiation in high risk breast cancer patients. Twenty-three patients with high risk breast cancer underwent neoadjuvant chemotherapy and multifractionated perioperative brachytherapy as a boost to the tumor bed using threedimensional (3D) CT-based planning. Plastic catheters for brachytherapy were implanted during surgery and targeted irradiation was delivered in the course of 2-3 weeks. Acute and late toxicities were scored according to the RTOG Common Toxicity Criteria. Cosmetic outcomes were assessed using the Harvard criteria. No major perioperative complications were recorded. Circumscribed wound infection occurred in one patient (4.3%). Only 3 patients (13%) experienced acute skin toxicity Grade 1. We observed no teleangiectasias or pigmentations. The cosmetic outcome at last follow-up visit was rated as excellent/good, in 82.6%, fair, in 13% and poor in 4.4% of patients, respectively. There was no evidence of disease recurrence after median follow-up of 43. 4 months. Systematic integration of the perioperative fractionated 3D CT-based HDR brachytherapy as a boost for patients with breast cancer after BCS is feasible and seems safe. It might be beneficial especially for women with high risk of local recurrence.

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“…[19,20] Previous studies have shown that clips do not always cover the tumor bed and the postoperative seroma; in some cases, the BV spreads out of the boundaries defined by clips. [21] While inclusion of the seroma along with the clips, therefore an increased BV for conventional surgery may be acceptable, the increased BV due to more extensive tissue removal and quadrant shifts in OPS may affect the accuracy of BV and the desired cosmetic outcomes. The cosmetic outcome of an increased BV needs to be further investigated.…”

Section: Discussionmentioning

confidence: 99%

Does Preoperative Positron Emission Tomography Help Delineate the Boost Volume After Oncoplastic Surgery for Breast Cancer?

Altinok¹

2017

TJ Oncol

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OBJECTIVEThe tumor bed within the breast shifts during oncoplastic surgery (OPS) for breast cancer (BC). Preoperative imagery is used to determine the boost volume (BV) for patients not implanted with surgical clips. This prospective study was conducted to geometrically compare BVs determined using preoperative imagery and BVs determined utilizing surgical clips. METHODSPatients diagnosed with BC were scanned using PET-CT during 2013-2015. Twenty patients who had undergone OPS but who did not have metastasis underwent CT prior to radiotherapy. Their preoperative images were fused with planning CT images. The tumor volume (CTVboost-pet), as determined from the preoperative PET-CT images, was contoured. Next, CTVboost-clips was determined using surgical clips. Geometric relationships between these two volumes were statistically compared. RESULTSPlanar projections of CTVboost-pet and CTVboost-clips were evaluated. Displacements between CTVboost-pet and CTVboost-clips in the axial (XZ) and coronal (XY) planes were 1.17 cm (min-max: 0.03-3.64 cm) and 1.67 cm (min-max: 0.38-4.14 cm), respectively, and were statistically significant (p<0.001), whereas the displacement in the sagittal (YZ) plane was 1.07 cm (min-max: 0.04-4.45 cm) and was not significant (p>0.7). CONCLUSIONPreoperative imaging alone was not reliable when determining the BV in patients who had undergone OPS and had no clips. Large PTV margins can be an option to overcome this issue. Surgical clips need to be inserted during OPS.

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Planning the breast boost: How accurately do surgical clips represent the CT seroma?

Cited by 48 publications

References 28 publications

Comparison of Magnetic Resonance Imaging and Computed Tomography for Breast Target Volume Delineation in Prone and Supine Positions

Comparison of Magnetic Resonance Imaging and Computed Tomography for Breast Target Volume Delineation in Prone and Supine Positions

Perioperative interstitial CT-based brachytherapy boost in breast cancer patients with breast conservation after neoadjuvant chemotherapy

Does Preoperative Positron Emission Tomography Help Delineate the Boost Volume After Oncoplastic Surgery for Breast Cancer?

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