Abstract
Introduction
In breast IMRT simultaneous integrated boost (SIB) treatment and accelerated partial breast irradiation (APBI), proper delineation of the tumor bed is necessary. Conservative oncoplastic surgery causes changes in peritumoral breast tissue that complicates locating the site of the tumor. Nevertheless, there are still centers that do not use surgical clips to delineate the site. This study aims to show how the lack of clips affects the techniques of SIB and APBI in terms of dose distribution and safety margins in the tumor bed.
Materials and methods
On 30 patients, the defining of the tumor bed obtained from the pre-surgery CT scan to that outlined on the basis of clips on the post-surgery CT was compared. Tumor bed deviation from the original tumor site was quantified. In addition, the margins to the original tumor site necessary to guarantee the coverage of the tumor bed were calculated.
Results
Variations were detected in the distances between geometric centers of the PTV (minimum 0.5–maximum 3 cm). The maximum margin necessary to include the entire tumor bed was 4.5 cm. Lesions located in the upper outer quadrant required the widest margins. If margins are not added, the tumor bed volume defined with clips will be underdosed.
Conclusions
The definition of the tumor bed based on studies before surgery does not have the necessary accuracy. Clips need to be placed in the surgical bed to identify the changes occurring after the restorative mammoplasty. Without clips, SIB and APBI are not safe.
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Any actual or potential conflicts of interest do not exist. The authors have no financial and personal relationship with other persons or organizations that could inappropriately influence their work.
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González Sanchis, A., Brualla González, L., Fuster Diana, C. et al. Tumor bed segmentation: first step for partial breast irradiation. Clin Transl Oncol 15, 39–45 (2013). https://doi.org/10.1007/s12094-012-0884-1
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DOI: https://doi.org/10.1007/s12094-012-0884-1