Tumour bed clip localisation for targeted breast radiotherapy: Compliance is proportional to trial-related research activity

Kirwan, Cliona C.; Sarakbi, Wail Al; Loncaster, Juliette A; Chan, HY; Thompson, Alistair; Wishart, Gordon

doi:10.1016/j.ejso.2013.11.016

Cited by 12 publications

(12 citation statements)

References 20 publications

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“…Ten of 31 referring surgeons routinely omitted clips and the omission rate was significantly higher for centres with low (≤ 1 patient) when compared with high (≥ 14 patients) rate of recruitment to IMRT clinical trials (67% vs . 27%, respectively; p < 0.001) 19. These results emphasize the need for good collaboration between radiation oncologists and surgeons and standardization of clip placement 9.…”

Section: Discussionmentioning

confidence: 71%

MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

Al-Hammadi

Caparrotti

Divakar

et al. 2017

Radiology and Oncology

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BackgroundOmitting the placement of clips inside tumour bed during breast cancer surgery poses a challenge for delineation of lumpectomy cavity clinical target volume (CTVLC). We aimed to quantify inter-observer variation and accuracy for CT- and MRI-based segmentation of CTVLC in patients without clips.Patients and methodsCT- and MRI-simulator images of 12 breast cancer patients, treated by breast conserving surgery and radiotherapy, were included in this study. Five radiation oncologists recorded the cavity visualization score (CVS) and delineated CTVLC on both modalities. Expert-consensus (EC) contours were delineated by a senior radiation oncologist, respecting opinions of all observers. Inter-observer volumetric variation and generalized conformity index (CIgen) were calculated. Deviations from EC contour were quantified by the accuracy index (AI) and inter-delineation distances (IDD).ResultsMean CVS was 3.88 +/− 0.99 and 3.05 +/− 1.07 for MRI and CT, respectively (p = 0.001). Mean volumes of CTVLC were similar: 154 +/− 26 cm3 on CT and 152 +/− 19 cm3 on MRI. Mean CIgen and AI were superior for MRI when compared with CT (CIgen: 0.74 +/− 0.07 vs. 0.67 +/− 0.12, p = 0.007; AI: 0.81 +/− 0.04 vs. 0.76 +/− 0.07; p = 0.004). CIgen and AI increased with increasing CVS. Mean IDD was 3 mm +/− 1.5 mm and 3.6 mm +/− 2.3 mm for MRI and CT, respectively (p = 0.017).ConclusionsWhen compared with CT, MRI improved visualization of post-lumpectomy changes, reduced interobserver variation and improved the accuracy of CTVLC contouring in patients without clips in the tumour bed. Further studies with bigger sample sizes are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 71%

MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

Al-Hammadi

Caparrotti

Divakar

et al. 2017

Radiology and Oncology

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“…Ataseven and colleagues22 reported that neoadjuvant chemotherapy‐induced pathological complete cancer response rates increased the surgical options for BCS without compromising clinical outcomes, an approach requiring future investigation. Future TM approaches for treating MIBC should recommend standardized operating procedures, involving tumour bed clips to facilitate image‐guided RT63, 64, 65, 66, 67, 68, 69. A minority of studies (8 of 24) in the present review referred to tumour bed boost RT following BCS for MIBC.…”

Section: Discussionmentioning

confidence: 98%

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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BackgroundThe clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers, collectively defined as multiple ipsilateral breast cancers (MIBC).MethodsComprehensive electronic searches were undertaken to identify complete papers published in English between May 1988 and July 2015, primarily comparing clinical outcomes of BCS and mastectomy for MIBC. All study designs were included, and studies were appraised critically using the Newcastle–Ottawa Scale. The characteristics and results of identified studies were summarized.ResultsTwenty‐four retrospective studies were included in the review: 17 comparative studies and seven case series. They included 3537 women with MIBC undergoing BCS; breast cancers were defined as MF in 2677 women, MC in 292, and reported as MIBC in 568. Six studies evaluated MIBC treated by BCS or mastectomy, with locoregional recurrence (LRR) rates of 2–23 per cent after BCS at median follow‐up of 59·5 (i.q.r. 56–81) months. BCS and mastectomy showed apparently equivalent rates of LRR (risk ratio 0·94, 95 per cent c.i. 0·65 to 1·36). Thirteen studies compared BCS in women with MIBC versus those with unifocal cancers, reporting LRR rates of 2–40 per cent after BCS at a median follow‐up of 64 (i.q.r. 57–73) months. One high‐quality study reported 10‐year actuarial LRR rates of 5·5 per cent for BCS in 300 women versus 6·5 per cent for mastectomy among 887 women.ConclusionThe available studies were mainly of moderate quality, historical and underpowered, with limited follow‐up and biased case selection favouring BCS rather than mastectomy for low‐risk patients. The evidence was inconclusive, weakening support for the St Gallen consensus and supporting a future randomized trial.

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“…For example after joining a clinical trial, the number of centres routinely using tumor bed clips to facilitate breast radiotherapy planning increased from 5 (19%) to 21 (81%) [32]. Based on these results, the authors suggested that clip insertion should be audited and considered as a measure of quality in breast surgery [31]. Such quality control is not unreasonable as clips likely add to better local control based on improved localization of the tumor bed.…”

Section: Discussionmentioning

confidence: 99%

Partial Breast Irradiation and Surgical Clip Usage for Tumor Bed Delineation After Breast-Conserving Surgery in Canada: A Radiation Oncology Perspective

Koch

Corey

Liu

et al. 2021

Advances in Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Tumour bed clip localisation for targeted breast radiotherapy: Compliance is proportional to trial-related research activity

Cited by 12 publications

References 20 publications

MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Partial Breast Irradiation and Surgical Clip Usage for Tumor Bed Delineation After Breast-Conserving Surgery in Canada: A Radiation Oncology Perspective

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