Document Type : Original Article
Department of Radiotherapy and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
Background: Based on the special pattern of recurrence in the excision cavity, secondary computed tomography (CT) can be introduced after hypofractionated whole breast radiotherapy with early breast cancer, aiming for accurate delineation of tumor bed boost and reduced toxicity. This study aimed to assess the volumetric changes in the lumpectomy cavity before and after hypofractionated whole breast radiation therapy (WBRT) and related clinical factors.
Method: This prospective study was designed and CT simulation was done for 45 patients from September 2019 to April 2020, two radiotherapy treatment planning were generated for each patient before and after hypofractionated WBRT. The tumor bed is defined using surgical clips, seroma, and postoperative alterations. Based on the original CT and tumor bed boost CT, statistically significant decrease was examined. The relationship between various factors and the volume decrease in the excision cavity was examined.
Results: The median value of reduction in the excision cavity was 15.4 cm3 with the statistical significance (P < 0.001). In multivariate linear regression, the significant variable which predict the volume reduction was the presence of seroma (B = 24.48, confidence interval, 13.09 to 35.87, P < 0.001).
Conclusion: our results suggested significant benefit from re-simulation before boost planning especially for patients with clinical evident seroma.
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination, and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.30476/mejc.2022.92301.1652
- Coughlin SS, Ekwueme DU. Breast cancer as a global health concern. Cancer Epidemiol. 2009;33(5):315-8. doi: 10.1016/j.canep.2009.10.003.
- Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, 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):3259-65. doi: 10.1200/JCO.2007.11.4991.
- Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, 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):1233-41. doi: 10.1056/NEJMoa022152.
- VanDongen JA, Voogd AC, Fenman IS, Legrand C, Sylvester JR, Tong D. Long‐term results of a randomized trial comparing breast‐conserving therapy with mastectomy: European Organizaon for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 2000;92:1143-50. doi: 10.1093/jnci/92.14.1143.
- Bartelink H, Horiot JC, Poortmans P, Struikmans H, Van den Bogaert W, Barillot I, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med. 2001;345(19):1378-87. doi: 10.1056/NEJMoa010874.
- Freedman GM, Anderson PR, Hanlon AL, Eisenberg DF, Nicolaou N. Pattern of local recurrence after conservative surgery and whole-breast irradiation. Int J Radiat Oncol Biol Phys. 2005;61(5):1328-36. doi: 10.1016/j.ijrobp.2004.08.026.
- Cho H and Kim C. Volumetric changes in the lumpectomy cavity during whole breast irradiation after breast conserving surgery. J Radiat Oncol, 2011;29(4):277-82. doi: 10.3857/roj.2011.29.4.27.
- Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, et al: Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010;362(6):513-20. doi: 10.1056/NEJMoa0906260.
- Haviland JS, Owen JR, Dewar JA, Barrett-Lee JP, Dobbs JH, Hopwood P, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomized controlled trials. Lancet Oncol. 2013;14(11):1086-94. doi: 10.1016/S1470-2045(13)70386-3.
- Kindts I, Laenen A, Depuydt T, Weltens C. Tumor bed boost radiotherapy for women after breast-conserving surgery. Cochrane Database Syst Rev. 2017;11(11):CD011987. doi: 10.1002/14651858.
- Poortmans PM, Collette L, Horiot JC, Bogaert WF, Fourquet A, Kuten A, et al. Impact of the boost dose of 10 Gy versus 26 Gy in patients with early stage breast cancer after a microscopically incomplete lumpectomy: 10-year results of the randomized EORTC boost trial. Radiother Oncol. 2009;90:80-5. doi: 10.1016/j.radonc.2008.07.011.
- Poortmans PM, Collette L, Bartelink H, Struikmans H, Bogaert WF, Fourquet A, et al. The addition of a boost dose on the primary tumor bed after lumpectomy in breast conserving treatment for breast cancer. A summary of the results of EORTC 22881-10882 “boost versus no boost” trial. Cancer Radiothery. 2008;12:565-70. doi: 10.1016/j.canrad.2008.07.014.
- Vrieling C, Collette L, Fourquet A, Hoogenraad JW, Horiot CJ, Jager JJ, et al. The influence of the boost in breast-conserving therapy on cosmetic outcome in the EORTC “boost versus no boost” trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. European Organization for Research and Treatment of Cancer. Int J Radiat Oncol Biol Phys. 1999;45:677-85. doi: 10.1016/s0360-3016(99)00211-4.
- Benda RK, Yasuda G, Sethi A, Gabram HS, Hinerman WR, Mendenhall PN. Breast boost: Are we missing the target? 2003;97:905-9. doi: 10.1002/cncr.11142.
- Prendergast B, Indelicato DJ, Grobmyer SR, Saito AI, Lightsey JL, Snead FE, 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. doi: 10.1016/j.ijrobp.2008.08.044.
- Sharma R, Spierer M, Mutyala S, Thawani N, Cohen HW, Hong L, et al. Change in seroma volume during whole-breast radiation therapy. Int J Radiat Oncol Biol Phys 2009;75:89-93. doi: 10.1016/j.ijrobp.2008.10.037.
- Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Sola AB, et al. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol. 2015;114:3-10. doi: 10.1016/j.radonc.2014.11.030.
- 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. doi: 10.1016/j.ijrobp.2006.04.042.
- Hepel JT, Evans SB, Hiatt JR, Price LL, DiPetrillo T, Wazer DE, 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. doi: 10.1016/j.ijrobp.2008.08.051.
- 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. Int J Radiat Oncol Biol Phys. 2009;74:1181-5. doi: 10.1016/j.ijrobp.2008.09.056.
- Flannery TW, Nichols EM, Cheston SB, Marter KM, Naqvi SA, Markham KM, 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. 24. doi: 10.1016/j.ijrobp.2008.11.024.
- 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(2):484-92. doi: 10.1016/j.ijrobp.2004.03.012.
- Whipp EC, Halliwell M. Magnetic resonance imaging appearance in the postoperative breast: The clinical target volume-tumor and its relationship to the chest wall. Int J Radiat Oncol Biol Phys. 2008;72(1):49-57. doi: 10.1016/j.ijrobp.2007.12.021.
- 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. doi: 10.1016/j.meddos.2004.10.002.
- Zhou ZR, Mei X, Chen XX, Yang ZZ, Hou J, Zhang L, et al. Systematic review and meta-analysis comparing hypofractionated with conventional fraction radiotherapy in treatment of early breast cancer. Surg Oncol. 2015;24(3):200-11. doi: 10.1016/j.suronc.2015.06.005.