A comparison between surgical scar and clips-guided treatment plans in breast electron boost

Abstract

OBJECTIVES In general, breast electron boost treatment planning is made using surgical scars or clips placed in the tumor bed. The aim of this study was to compare these two treatments plans in terms of dose optimization. METHODS Twenty-five patients who had surgical clips placed in the tumor bed during tumor excision were evaluated. At first, surgical clips were not taken into account in these patients (type I). In the secondary stage, the treatment plan (type II) was performed considering surgical clips. Taking type II treatment plan as a basis, type I treatment plan was compared in terms of energy, field size, gantry angle, collimator angle and field center parameters. RESULTS When compared with Type I plan, changes were observed in the electron energy used in the treatment of 12 patients, the electron fields of 20 patients, the gantry angles of 12 patients, the collimator angles of 6 patients and the field centers of 18 patients when surgical clips were considered. CONCLUSION This study demonstrates that in breast boost irradiation, conformal planning made using CT slices was preferred to obtain optimum dose distribution at the target volume.

Keywords

• Breast,Mastectomy, Segmental,Surgical Instruments,Radiotherapy,Electrons,Comparative Study

Memenin elektron huzmesi ile ek doz tedavisinde cerrahi skara ve kliplere dayalı tedavi planlamalarının karşılaştırılması

Abstract

Meme koruyucu cerrahi sonrası radyoterapide, elektron ek doz (boost) alanının, klinik verilerle cerrahi insizyona göre ve kliplere göre saptandığı iki farklı tedavi planlaması, doz optimizasyonu yönünden karşılaştırıldı. GEREÇ VE YÖNTEM Çalışma, cerrahi girişim sırasında tümör yatağının sınırları kliplerle işaretlenmiş 25 hastada yapıldı. İlk aşamada, bu hastalarda cerrahi klipler gözönüne alınmadı (tip I). Daha sonra cerrahi klipler dikkate alınarak 3D tedavi planlaması yapıldı (tip II). Tip II planlama esas alınarak tip I'e dayalı planlama; enerji, alan boyutu, gantri açısı, kolimatör açısı ve alan merkezi parametreleri karşılaştırıldı. BULGULAR Yapılan karşılaştırma sonucuna göre tip I planlamada; 25 hastanın 12'sinde enerji, 20'sinde alan boyutu, 12'sinde gantri açısı, 6'sında kolimatör açısı ve 18'inde de alan merkezi üzerinde değişiklik gerekti. SONUÇ Bu veriler ışığında lokal başarısızlığı azaltmak ve hedef hacimde optimum doz dağılımı elde etmek için, meme ek doz ışınlamasında bilgisayarlı tomografi kesitleri üzerinden konformal planlama yapılmasını önermekteyiz.

Keywords

• Ek tedavi, elektron, klip, meme

References

1. 1. Touboul E, Belkacemi Y, Lefranc JP, Uzan S, Ozsahin M, Korbas D, et al. Early breast cancer: influence of type of boost (electrons vs iridium-192 implant) on local control and cosmesis after conservative surgery and radiation therapy. Radiother Oncol 1995;34(2):105-13.
2. 2. Bedwinek J. Treatment of stage I and II adenocarcinoma of the breast by tumor excision and irradiation. Int J Radiat Oncol Biol Phys 1981;7(11):1553-9.
3. 3. Clarke D, Martinez A, Cox RS. Analysis of cosmetic results and complications in patients with stage I and II breast cancer treated by biopsy and irradiation. Int J Radiat Oncol Biol Phys 1983;9(12):1807-13.
4. 4. Harrington KJ, Harrison M, Bayle P, Evans K, Dunn PA, Lambert HE, 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):579-84.
5. 5. Perez AC, Gorcia DM, Kuske RR, Levitt SH. Breast: Stage Tis, TI, and T2 tumors. In: Perez CA, Brady LW, editors. Principles and practice of radiation o n c o l o g y. 2nd ed. Philadelphia: J.B. Lippincott Company; 1992. p. 877-947.
6. 6. Sedlmayer F, Rahim HB, Kogelnik HD, Menzel C, Merz F, Deutschmann H, et al. Quality assurance in breast cancer brachytherapy: geographic miss in the interstitial boost treatment of the tumor bed. Int J Radiat Oncol Biol Phys 1996;34(5):1133-9.
7. 7. Solin LJ, Chu JC, Larsen R, Fowble B, Galvin JM, Goodman RL. Determination of depth for electron breast boosts. Int J Radiat Oncol Biol Phys 1987;13(12):1915-9.
8. 8. Solin LJ, Danoff BF, Schwartz GF, Galvin JM, Goodman RL. A practical technique for the localization of the tumor volume in definitive irradiation of the breast. Int J Radiat Oncol Biol Phys 1985;11(6):1215-20.

9. 9. Ray GR, Fish VJ. Biopsy and definitive radiation therapy in Stage I and II adenocarcinoma of the female breast: analysis of cosmesis and the role of electron beam supplementation. Int J Radiat Oncol Biol Phys 1983;9(6):813-8.
10. 10.Recht A, Harris JR. To boost or not to boost, and how to do it. Int J Radiat Oncol Biol Phys 1991;20(1):177-8.
11. 11. 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(3):239-43.
12. 12. Perez CA, Taylor ME, Halverson K, Garcia D, Kuske RR, Lockett MA. Brachytherapy or electron beam boost in conservation therapy of carcinoma of the breast: a nonrandomized comparison. Int J Radiat Oncol Biol Phys 1996;34(5):995-1007.
13. 13.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(1):121-5.
14. 14. Aslay I, Töre G, Bilge N, Kizir A, Tütün A, Özbay I. Meme kanserinde postoperatif gö¤üs ceperi ›fl›nlama planlamas›nda ultrasound’un kullan›m›. Türk Onkoloji Dergisi 1990;5:991-5.
15. 15. Klevenhagen SC. Physics of electron beam therapy. Medical Physics Handbooks 13; 1985.
16. 16. Purdy JA, Glasgow GP, Lightfoot DA. Principles of radiology physics, dosimetry, and treatment planning. In: Perez CA, Brady LW, editors. Principles and practice of radiation oncology. 2nd ed. Philadelphia: J.B. Lippincott Company; 1992. p. 183-207.
17. 17. Purdy JA, Glasgow GP. External beam dosimetry and treatment planning. In: Perez CA, Brady LW, editors. Principles and practice of radiation oncology. 2nd ed. Philadelphia: J.B. Lippincott Company; 1992. p. 208- 45.
18. 18.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(4):675-9.
19. 19. 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(1):43-8.