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

Coles, Charlotte E.; Wilson, Charles B.; Cumming, Joseph; Benson, John R.; Forouhi, Parto; Wilkinson, Jennifer; Jena, R.; Wishart, Gordon

doi:10.1016/j.ejso.2008.09.005

Cited by 96 publications

(72 citation statements)

References 11 publications

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“…When EBRT is carried out, haemoclips can help to localise the target area using conventional or CT-simulator [11]. Nevertheless, the postoperative changes and tissue remodelling make sometimes the localization of the tumor bed difficult [12,13,14].…”

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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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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“…Although low levels of local recurrence (1.1% at 5 years) can be achieved with a 5mm target margin [19], a recent review suggests that a 2mm margin may be adequate [20] following BCS for ductal carcinoma in situ. Recent developments in BCS have centred on the use of oncoplastic techniques to improve post-operative cosmesis [21], especially in medial and lower quadrant tumours, and tumour bed localisation with titanium clips to facilitate targeted radiotherapy [22]. The last ten years, however, have seen a major paradigm shift in axillary lymph node staging with the introduction of sentinel lymph node biopsy (SLNB).…”

Section: Surgerymentioning

confidence: 99%

New technological developments in the diagnosis and surgical management of breast cancer

Wishart

Pitsinis

2010

Hellenic J Surg

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“…Some have advocated the use of surgical clips with or without seroma, others have used only seroma cavity [3,4] . In Europe, CT and clip-based TB delineation is considered as the gold standard [9]. However, by placing the patient in Pr, the size and shape of the breast and TB are significantly modified.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Treatment Position (Prone vs. Supine) on Clip Displacement, Seroma, Tumor Bed and Partial Breast Target Volumes: Comparative Study

Lakosi¹,

Gulybán²,

Simoni³

et al. 2015

Pathol. Oncol. Res.

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To analyse the displacement of surgical clips in prone (Pr) position and assess the consequences on target volumes and integral dose of partial breast irradiation (PBI). 30 post-lumpectomy breast cancer patients underwent CT imaging in supine (Su) and Pr. Clip displacements were measured by the distances from the clips to a common fix bony reference point. On each dataset, the tumour bed (TB = clips ± seroma), clinical target volume (CTV = TB + 1.5 cm) and planning target volumes (PTV = CTV + 1 cm) for PBI were determined and the volume pairs were compared. Furthermore estimation of integral dose ratio (IDR) within the breast from tangential treatment was performed as the ratio of the irradiated breast volume and the volume encompassing all clips. Clips close to the chest wall (CW) in Su showed significantly less displacement in Pr. The mean volumes of seroma, CTV and PTV were significantly higher in Pr than in Su. The PTV volume difference (Pr-Su) was significantly higher in patients with presence of seroma, deep clips and TB location in the superior-internal-quadrant (SIQ) and at the junction of superior quadrants (jSQ). In a multivariate analysis two factors remained significant: seroma and TB localization in SIQ-jSQ. The IDR was significantly larger in Su than in Pr (7.6 vs. 4.1 p < 0.01). Clip displacements varied considerably with respect to their relative position to the CW. In selected patients Pr position potentially leads to a significant increase in target volumes of PBI. Tangential beam arrangement for PBI should be avoided, not only in Su but in Pr as well in case of clip-based target volume definition.

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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 96 publications

References 11 publications

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

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

New technological developments in the diagnosis and surgical management of breast cancer

The Influence of Treatment Position (Prone vs. Supine) on Clip Displacement, Seroma, Tumor Bed and Partial Breast Target Volumes: Comparative Study

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