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Tumor bed segmentation: first step for partial breast irradiation.

Amparo González Sanchis¹, Luis Brualla González, Carlos Fuster Diana

¹Radiation Oncology Department, ERESA, Hospital General Universitario de Valencia, Avenida Tres Cruces no 2, Valencia, Spain. agonzalez@eresa.com

Clinical & Translational Oncology : Official Publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico

|August 3, 2012

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Surgical clips are essential for accurate tumor bed delineation in breast cancer radiotherapy. Without them, simultaneous integrated boost (SIB) and accelerated partial breast irradiation (APBI) techniques risk underdosing the tumor bed, compromising treatment safety.

Area of Science:

Radiation Oncology
Surgical Oncology
Medical Imaging

Background:

Accurate tumor bed delineation is critical for breast cancer radiotherapy techniques like simultaneous integrated boost (SIB) and accelerated partial breast irradiation (APBI).
Oncoplastic surgery can alter breast tissue, complicating tumor site identification.
Some centers do not utilize surgical clips for tumor bed localization.

Purpose of the Study:

To evaluate the impact of surgical clip absence on SIB and APBI treatment planning.
To assess dose distribution and safety margins in the tumor bed without clip-based delineation.
To determine the accuracy of pre-surgery imaging for tumor bed definition compared to post-surgery clip placement.

Main Methods:

Comparison of tumor bed definition from pre-surgery CT scans versus post-surgery CT scans with clips in 30 patients.

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Quantification of tumor bed deviation from the original tumor site.

Calculation of necessary margins to ensure complete tumor bed coverage.

Main Results:

Significant variations in the distances between geometric centers of the planning target volume (PTV) were observed (0.5-3 cm).
A maximum margin of 4.5 cm was required to encompass the entire tumor bed.
Lesions in the upper outer quadrant necessitated the widest margins.
Omitting margins led to underdosing of the tumor bed volume defined by clips.

Conclusions:

Pre-surgery imaging alone lacks the accuracy for precise tumor bed definition in post-operative breast radiotherapy.
Surgical clips are crucial for identifying post-mammoplasty changes and ensuring accurate treatment targeting.
SIB and APBI treatments are not considered safe without the use of surgical clips for tumor bed localization.