Treatment planningDosimetric impact of post-operative seroma reduction during radiotherapy after breast-conserving surgery
Section snippets
Patient data
Twenty-one patients who received breast-conserving therapy in 2008 and developed seroma in the excision cavity after undergoing microscopically complete tumor excision were consecutively selected for this study. The patients were recruited from two different RT departments within The Netherlands: The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam (n = 12) and Catharina Hospital, Eindhoven (n = 9). No patients in our study received neo-adjuvant chemotherapy. An overview of
Results
All generated treatment plans adhered to clinical requirements. An overview of the target coverage is given in Table 2. Table 3 summarizes the means and significant effects found for Vpatient, 107%(breast-dose), Vpatient, 95%(total-dose), Voutside PTVboost, 95%(total-dose), HDmax and MLD.
Discussion
The aim of this study was to retrospectively compare three boost RT planning techniques (SEQ, SIB and SIB-ART) in patients who developed seroma after breast-conserving surgery. This study showed that irradiated boost volumes were significantly smaller with SIB-ART, despite the apparent advantage of a sequential boost with respect to seroma shrinkage. The three techniques only slightly differed in dose delivery to the lungs and heart. Therefore, our study indicates a clinical preference for
Conclusions
Seroma is frequently seen in patients after breast-conserving surgery. Reduction is normally seen during the first weeks of adjuvant radiotherapy [3], [9]. Our study demonstrates that, for patients with seroma reduction, a tighter dose distribution from the start of treatment (SIB) outweighs the advantage of sequential boost planning (SEQ) provided that the delivery of SIB is re-planned halfway through treatment. This leads us to the conclusion that SIB-ART is the optimal boost radiation
Conflict of interest statement
The authors of this manuscript have no actual or potential conflicts of interest to disclose.
Acknowledgments
The authors would like to thank J. van der Leer, RT(T) (Department of Radiation Therapy, Catharina Hospital, Eindhoven, The Netherlands) and D. Minkema, RT(T) (Department of Radiation Oncology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands) for their contributions to this study. Financial support of this work was provided by the Dutch Cancer Society (Grant No. KWF 2008-4024).
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2014, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :In such circumstances, adaptive replanning, either online or offline, can be introduced to maintain the optimal dose delivery (8-12). Recent studies report that the LC change during breast RT is an unavoidable critical issue and that a midway replanning may benefit in preventing geometric missing and/or unnecessary toxicity (13-15). The focus of those studies was mostly on the LC volume reduction.