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Tumour bed localisation after oncoplastic breast conservative surgery: a comparative contouring study

Published online by Cambridge University Press:  13 September 2018

Radwa Fawzy ,
Shaimaa Lasheen ,
Maha Kamaleldin ,
Rasha Wessam ,
Emad Khallaf  and
Mohamed Moussa
Radwa Fawzy*
Affiliation:
Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Shaimaa Lasheen
Affiliation:
Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Maha Kamaleldin
Affiliation:
Department of Medical Physics, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Rasha Wessam
Affiliation:
Department of Diagnostic Radiology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Emad Khallaf
Affiliation:
Department of General Surgery, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Mohamed Moussa
Affiliation:
Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
*
Author for correspondence: Radwa Fawzy, Department of Clinical Oncology, Kasr Al-Ainy School of Medicine, Cairo University, 9th Abdel Aziz Khedr from 106 street, Cairo 11728, Egypt, E-mail: radwa.fawzy@kasralainy.edu.eg
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Abstract

Purpose

To investigate the modalities of tumour bed (TB) localisation of target volume delineation [clinically computed tomography (CT), ultrasound (US) compared with surgical clips-guided] and the impact of their differences in delineated TB volumes.

Material and methods

In total, 27 patients who underwent oncoplastic breast conservative surgery with surgical clips insertion (at least three) were included. CT and US imaging for TB localisation were done 3–4 weeks post-operatively in the same treatment position. TB was delineated four times, guided by surgical clips, clinical data, CT (seroma) and US. A plan was done for each TB delineated. The four delineated volumes were compared regarding the volumetric differences, the geographical miss index (GMI) and the overlap index.

Results

Comparing the four modalities, median TB volume was for clinical (60.7), CT (60.8) and US (49.3) cm3, in comparison with 59.7 cm3 for clips, p=0.05. Median of GMI (represented the tissue at risk of recurrence and not had been treated) was for clinical (61.8), CT (45) and US (62.4)%, with significant difference of p=0.02. Median of normal tissue index (normal tissue has been included unnecessarily) was for clinical (59.5), CT (49.6) and US (62.3)%, p=0.17. Overlap index with clips-guided was for clinical (0.36), CT (0.42) and US (0.35) with significance of p=0.04. Median superior/inferior direction was 0.72, −0.03 and −0.2 cm for clinical, CT and US, respectively, with significant value of p=0.02, whereas the anterior–posterior was −0.07, −0.15 and −0.09 cm, p-value=0.45 and the medio–lateral was 0.4, −0.13 and 0.09 cm, p=0.60.

Conclusion

Significant differences in shifts and indices were detected between each of modalities compared with surgical clips. Thus, in the setting of oncoplastic breast surgery, surgical clips should be routinely used for TB localisation. In view of the larger volumes of breast tissue excised and the extensive remodelling that are inherent to oncoplastic procedures, the concept of TB boost irradiation should be re-challenged.

Keywords

boost irradiationboost localisationbreast conservativegeographical missoncoplastic surgerysurgical clipstumour bed
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 18 , Issue 1 , March 2019 , pp. 63 - 69
Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Fawzy R, Lasheen S, Kamaleldin M, Wessam R, Khallaf E, Moussa M. (2019) Tumour bed localisation after oncoplastic breast conservative surgery: a comparative contouring study. Journal of Radiotherapy in Practice18: 63–69. doi: 10.1017/S1460396918000389

References

1. Clarke, M, Collins, R, Darby, S et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 366 (9503): 2087–2106.Google Scholar
2. Fisher, B, Anderson, S, Bryant, J et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347 (16): 1233–1241.Google Scholar
3. Veronesi, U, Cascinelli, N, Mariani, L et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347 (16): 1227–1232.Google Scholar
4. Vrieling, C, van Werkhoven, E, Maingon, P et al. Prognostic factors for local control in breast cancer after long-term follow-up in the eortc boost vs no boost trial: a randomized clinical trial. JAMA Oncol 2017; 3 (1): 42–48.Google Scholar
5. Bartelink, H, Horiot, J-C, Poortmans, P M et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 2007; 25 (22): 3259–3265.Google Scholar
6. Ozmen, T, Polat, A V, Polat, A K, Bonaventura, M, Johnson, R, Soran, A. Factors affecting cosmesis after breast conserving surgery without oncoplastic techniques in an experienced comprehensive breast center. Surgeon 2015; 13 (3): 139–144.Google Scholar
7. Hansen, C J, de Winton, E, Guglani, S, Vamvakas, E, Willis, D, Chua, B H. Target localisation for tumour bed radiotherapy in early breast cancer. J Med Imaging Radiat Oncol 2012; 56 (4): 452–457.Google Scholar
8. Macmillan, R D, McCulley, S J. Oncoplastic breast surgery: what, when and for whom? Curr Breast Cancer Rep 8: 112–117.Google Scholar
9.Edge S B, Byrd D R, Compton C C, Fritz A G, Greene F L, Trotti A (eds). AJCC cancer staging manual, 7th edition. France: Springer, 2010.Google Scholar
10. Harrington, K J, Harrison, M, Bayle, P et al. Surgical clips in planning the electron boost in breast cancer: a qualitative and quantitative evaluation. Int J Radiat Oncol Biol Phys 1996; 34 (3): 579–584.Google Scholar
11. Sharma, R, Spierer, M, Mutyala, S et al. Change in seroma volume during whole-breast radiation therapy. Int J Radiat Oncol Biol Phys 2009; 75 (1): 89–93.Google Scholar
12. Schaverien, M V, Stallard, S, Dodwell, D, Doughty, J C. Use of boost radiotherapy in oncoplastic breast-conserving surgery—a systematic review. Eur J Surg Oncol 2013; 39 (11): 1179–1185.Google Scholar
13. Kovner, F, Agay, R, Merimsky, O, Stadler, J, Klausner, J, Inbar, M. Clips and scar as the guidelines for breast radiation boost after lumpectomy. Eur J Surg Oncol 1999; 25 (5): 483–486.Google Scholar
14. Goldberg, H, Prosnitz, R G, Olson, J A, Marks, L B. Definition of postlumpectomy tumor bed for radiotherapy boost field planning: CT versus surgical clips. Int J Radiat Oncol Biol Phys 2005; 63 (1): 209–213.Google Scholar
15. Ringash, J, Whelan, T, Elliott, E et al. Accuracy of ultrasound in localization of breast boost field. Radiother Oncol 2004; 72 (1): 61–66.Google Scholar
16. Wong, P, Muanza, T, Reynard, E, Robert, K, Barker, J, Sultanem, K. Use of three-dimensional ultrasound in the detection of breast tumor bed displacement during radiotherapy. Int J Radiat Oncol Biol Phys 2011; 79 (1): 39–45.Google Scholar
17. Ippolito, E, Trodella, L, Silipigni, S et al. Estimating the value of surgical clips for target volume delineation in external beam partial breast radiotherapy. Clin Oncol (R Coll Radiol) 2014; 26 (11): 677–683.Google Scholar