Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Volumetric changes in the lumpectomy cavity during whole breast irradiation after breast conserving surgery

  • Cho, Heung-Lae (Department of Radiation Oncology, Inje University College of Medicine) ;
  • Kim, Cheol-Jin (Department of Radiation Oncology, Inje University College of Medicine)
  • Received : 2011.10.17
  • Accepted : 2011.10.28
  • Published : 2011.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study was performed to evaluate the change in the lumpectomy cavity volumes before and after whole breast radiation therapy (WBRT) and to identify factors associated with the change of volume. Materials and Methods: From September 2009 to April 2010, the computed tomography (CT) simulation data from 70 patients obtained before and after WBRT was evaluated. The lumpectomy cavity volumes were contoured based on surgical clips, seroma, and postoperative changes. Significant differences in the data from pre-WBRT CT and post-WBRT CT were assessed. Multiple variables were examined for correlation with volume reduction in the lumpectomy cavity. Results: The mean and median volume reduction in the lumpectomy cavity after WBRT were 17.6 $cm^3$ and 16.1 $cm^3$, respectively with the statistical significance (p < 0.001). The volume reduction in the lumpectomy cavity was inversely correlated with time from surgery to radiation therapy (R = 0.390). The presence of seroma was significantly associated with a volumetric change in the lumpectomy cavity after WBRT (p = 0.011). Conclusion: The volume of lumpectomy cavity reduced significantly after WBRT. As the time from surgery to the start ot WBRT increased, the volume reduction in the lumpectomy cavity during WBRT decreased. A strong correlation was observed between the presence of seroma and the reduced volume. To ensure appropriate coverage and to limit normal tissue exposure during boost irradiation in patients who has seroma at the time of starting WBRT, repeating CT simulation at boost planning is suggested.

Keywords

References

  1. Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of followup in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995;333:1456-61. https://doi.org/10.1056/NEJM199511303332203
  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;347:1233-41. https://doi.org/10.1056/NEJMoa022152
  3. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year followup of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227-32. https://doi.org/10.1056/NEJMoa020989
  4. Cho H, Kim C, Park S, Oh M, Lee J, Ahn K. Clinical outcome after breast conserving surgery and radiation therapy for early breast cancer. J Korean Soc Ther Radiol Oncol 2008;26:204-12. https://doi.org/10.3857/jkstro.2008.26.4.204
  5. Ahn SH, Yoo KY; Korean Breast Cancer Society. Chronological changes of clinical characteristics in 31,115 new breast cancer patients among Koreans during 1996-2004. Breast Cancer Res Treat 2006;99:209-14. https://doi.org/10.1007/s10549-006-9188-x
  6. Clark RM, Whelan T, Levine M, et al. Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. Ontario Clinical Oncology Group. J Natl Cancer Inst 1996;88:1659-64. https://doi.org/10.1093/jnci/88.22.1659
  7. Gage I, Recht A, Gelman R, et al. Long-term outcome following breast-conserving surgery and radiation therapy. Int J Radiat Oncol Biol Phys 1995;33:245-51. https://doi.org/10.1016/0360-3016(95)02001-R
  8. Romestaing P, Lehingue Y, Carrie C, et al. Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. J Clin Oncol 1997;15:963-8.
  9. Bartelink H, Horiot JC, Poortmans P, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 2001;345: 1378-87. https://doi.org/10.1056/NEJMoa010874
  10. Bartelink H, Horiot JC, Poortmans PM, et al. Impact of a higher radiation dose on local control and survival in breastconserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 2007;25:3259-65. https://doi.org/10.1200/JCO.2007.11.4991
  11. Oh KS, Kong FM, Griffith KA, Yanke B, Pierce LJ. Planning the breast tumor bed boost: changes in the excision cavity volume and surgical scar location after breast-conserving surgery and whole-breast irradiation. Int J Radiat Oncol Biol Phys 2006;66:680-6. https://doi.org/10.1016/j.ijrobp.2006.04.042
  12. Prendergast B, Indelicato DJ, Grobmyer SR, et al. The dynamic tumor bed: volumetric changes in the lumpectomy cavity during breast-conserving therapy. Int J Radiat Oncol Biol Phys 2009;74:695-701. https://doi.org/10.1016/j.ijrobp.2008.08.044
  13. Sharma R, Spierer M, Mutyala S, et al. Change in seroma volume during whole-breast radiation therapy. Int J Radiat Oncol Biol Phys 2009;75:89-93. https://doi.org/10.1016/j.ijrobp.2008.10.037
  14. Vicini F, White J, Arthur D, et al. NSABP B-39/RTOG 0413: a randomized phase III study of conventional whole breast irradiation versus partial breast irradiation for women with stage 0, I, or II breast cancer, ver. March 13, 2007 [Internet]. [cited 2011 Oct 10].
  15. Bedwinek J. Breast conserving surgery and irradiation: the importance of demarcating the excision cavity with surgical clips. Int J Radiat Oncol Biol Phys 1993;26:675-9. https://doi.org/10.1016/0360-3016(93)90287-6
  16. Harrington KJ, 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;34:579-84. https://doi.org/10.1016/0360-3016(95)02090-X
  17. Machtay M, Lanciano R, Hoffman J, Hanks GE. Inaccuracies in using the lumpectomy scar for planning electron boosts in primary breast carcinoma. Int J Radiat Oncol Biol Phys 1994;30:43-8. https://doi.org/10.1016/0360-3016(94)90517-7
  18. Regine WF, Ayyangar KM, Komarnicky LT, Bhandare N, Mansfield CM. Computer-CT planning of the electron boost in definitive breast irradiation. Int J Radiat Oncol Biol Phys 1991;20:121-5. https://doi.org/10.1016/0360-3016(91)90147-V
  19. Messer PM, Kirikuta IC, Bratengeier K, Flentje M. CT planning of boost irradiation in radiotherapy of breast cancer after conservative surgery. Radiother Oncol 1997;42:239-43. https://doi.org/10.1016/S0167-8140(96)01891-9
  20. Hepel JT, Evans SB, Hiatt JR, et al. Planning the breast boost: comparison of three techniques and evolution of tumor bed during treatment. Int J Radiat Oncol Biol Phys 2009;74:458- 63. https://doi.org/10.1016/j.ijrobp.2008.08.051
  21. Benda RK, Yasuda G, Sethi A, Gabram SG, Hinerman RW, Mendenhall NP. Breast boost: are we missing the target? Cancer 2003;97:905-9. https://doi.org/10.1002/cncr.11142
  22. Tersteeg RJ, Roesink JM, Albregts M, Warlam-Rodenhuis CC, van Asselen B. Changes in excision cavity volume: prediction of the reduction in absolute volume during breast irradiation. Int J Radiat Oncol Biol Phys 2009;74:1181-5. https://doi.org/10.1016/j.ijrobp.2008.09.056
  23. Flannery TW, Nichols EM, Cheston SB, et al. Repeat computed tomography simulation to assess lumpectomy cavity volume during whole-breast irradiation. Int J Radiat Oncol Biol Phys 2009;75:751-6. https://doi.org/10.1016/j.ijrobp.2008.11.024
  24. Huh SJ, Han Y, Park W, Yang JH. Interfractional dose variation due to seromas in radiotherapy of breast cancer. Med Dosim 2005;30:8-11. https://doi.org/10.1016/j.meddos.2004.10.002
  25. Weed DW, Yan D, Martinez AA, Vicini FA, Wilkinson TJ, Wong J. The validity of surgical clips as a radiographic surrogate for the lumpectomy cavity in image-guided accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2004;60:484- 92. https://doi.org/10.1016/j.ijrobp.2004.03.012
  26. Jacobson G, Betts V, Smith B. Change in volume of lumpectomy cavity during external-beam irradiation of the intact breast. Int J Radiat Oncol Biol Phys 2006;65:1161-4. https://doi.org/10.1016/j.ijrobp.2006.02.009
  27. Bantema-Joppe EJ, van der Laan HP, de Bock GH, et al. Threedimensional conformal hypofractionated simultaneous integrated boost in breast conserving therapy: results on local control and survival. Radiother Oncol 2011;100:215-20. https://doi.org/10.1016/j.radonc.2011.05.027
  28. Hijal T, Fournier-Bidoz N, Castro-Pena P, et al. Simultaneous integrated boost in breast conserving treatment of breast cancer: a dosimetric comparison of helical tomotherapy and three-dimensional conformal radiotherapy. Radiother Oncol 2010;94:300-6. https://doi.org/10.1016/j.radonc.2009.12.043
  29. Singla R, King S, Albuquerque K, Creech S, Dogan N. Simultaneous-integrated boost intensity-modulated radiation therapy (SIB-IMRT) in the treatment of early-stage left-sided breast carcinoma. Med Dosim 2006;31:190-6. https://doi.org/10.1016/j.meddos.2005.11.001

Cited by

  1. Tumor bed volumetric changes during breast irradiation for the patients with breast cancer vol.31, pp.4, 2011, https://doi.org/10.3857/roj.2013.31.4.228
  2. Seroma change during magnetic resonance imaging-guided partial breast irradiation and its clinical implications vol.12, pp.None, 2011, https://doi.org/10.1186/s13014-017-0843-7
  3. Evaluation of adaptive radiotherapy (ART) by use of replanning the tumor bed boost with repeated computed tomography (CT) simulation after whole breast irradiation (WBI) for breast cancer patients hav vol.36, pp.6, 2011, https://doi.org/10.1007/s11604-018-0735-2
  4. Adaptive radiation therapy of breast cancer by repeated imaging during irradiation vol.12, pp.5, 2020, https://doi.org/10.4329/wjr.v12.i5.68