Abstract
Objective:Planning of breast radiation for patients with breast conserving surgery often relies on clinical markers such as scars. Lately, surgical clips have been used to identify the tumor location. The purpose of this study was to evaluate the geographic miss index (GMI) and the normal tissue index (NTI) for the electron boost in breast cancer treatment plans with and without surgical clips.Material and Methods:A retrospective descriptive study of 110 consecutive post-surgical patients who underwent breast-conserving treatment in early breast cancer, in which the clinical treatment field with the radiologic (clipped) field were compared and GMI/NTI for the electron boost were calculated respectively.Results:The average clinical field was 100 mm (range, 100-120 mm) and the clipped field was 90 mm (range, 80-100 mm). The average GMI was 11.3% (range, 0-44%), and the average NTI was 27.5% (range, 0-54%). The GMI and NTI were reduced through the use of intra-surgically placed clips.Conclusion:The impact of local tumor control on the survival of patients with breast cancer is also influenced by the precision of radiotherapy. Additionally, patients demand an appealing cosmetic result. This makes “clinical” markers such as scars unreliable for radiotherapy planning. A simple way of identifying the tissue at risk is by intra-surgical clipping of the tumor bed. Our results show that the use of surgical clips can reduce the diameter of the radiotherapy field and increase the accuracy of radiotherapy planning. With the placement of surgical clips, more tissue at risk is included in the radiotherapy field. Less normal tissue receives radiotherapy with the use of surgical clips.
Highlights
Wide local excision is the current surgical treatment for most early breast cancers
The surgical resection margin has been identified as a marker for recurrence rates and the influence of boost radiation [15, 16]
The accuracy of the boost can be judged by the geographic miss index (GMI) and normal tissue index (NTI)
Summary
Wide local excision is the current surgical treatment for most early breast cancers. In today’s practice, surgeons 'hide' scars around the areola, laterally in the lower axilla or underneath the breast. Guidelines recommend that breast conserving surgery is accompanied by whole breast irradiation. The benefit of guideline-adherent radiotherapy has been clearly demonstrated [2,3,4,5]; clinical 'landmarks' (i.e. scars) for radiotherapy treatment planning are becoming less reliable. The use of surgical clips has been discussed in the last decade [6,7,8,9]. The use of clips has not been established routinely in some centers, as such proof for the dosimetric advantage is still pending. To estimate the accuracy of radiotherapy treatment, the geographic miss index (GMI) and the normal tissue index
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