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Tumour bed localisation after oncoplastic breast conservative surgery: a comparative contouring study

Published online by Cambridge University Press:  13 September 2018

Radwa Fawzy ,
Shaimaa Lasheen ,
Maha Kamaleldin ,
Rasha Wessam ,
Emad Khallaf  and
Mohamed Moussa
Radwa Fawzy*
Affiliation:
Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Shaimaa Lasheen
Affiliation:
Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Maha Kamaleldin
Affiliation:
Department of Medical Physics, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Rasha Wessam
Affiliation:
Department of Diagnostic Radiology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Emad Khallaf
Affiliation:
Department of General Surgery, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Mohamed Moussa
Affiliation:
Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
*
Author for correspondence: Radwa Fawzy, Department of Clinical Oncology, Kasr Al-Ainy School of Medicine, Cairo University, 9th Abdel Aziz Khedr from 106 street, Cairo 11728, Egypt, E-mail: radwa.fawzy@kasralainy.edu.eg
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Abstract

Purpose

To investigate the modalities of tumour bed (TB) localisation of target volume delineation [clinically computed tomography (CT), ultrasound (US) compared with surgical clips-guided] and the impact of their differences in delineated TB volumes.

Material and methods

In total, 27 patients who underwent oncoplastic breast conservative surgery with surgical clips insertion (at least three) were included. CT and US imaging for TB localisation were done 3–4 weeks post-operatively in the same treatment position. TB was delineated four times, guided by surgical clips, clinical data, CT (seroma) and US. A plan was done for each TB delineated. The four delineated volumes were compared regarding the volumetric differences, the geographical miss index (GMI) and the overlap index.

Results

Comparing the four modalities, median TB volume was for clinical (60.7), CT (60.8) and US (49.3) cm3, in comparison with 59.7 cm3 for clips, p=0.05. Median of GMI (represented the tissue at risk of recurrence and not had been treated) was for clinical (61.8), CT (45) and US (62.4)%, with significant difference of p=0.02. Median of normal tissue index (normal tissue has been included unnecessarily) was for clinical (59.5), CT (49.6) and US (62.3)%, p=0.17. Overlap index with clips-guided was for clinical (0.36), CT (0.42) and US (0.35) with significance of p=0.04. Median superior/inferior direction was 0.72, −0.03 and −0.2 cm for clinical, CT and US, respectively, with significant value of p=0.02, whereas the anterior–posterior was −0.07, −0.15 and −0.09 cm, p-value=0.45 and the medio–lateral was 0.4, −0.13 and 0.09 cm, p=0.60.

Conclusion

Significant differences in shifts and indices were detected between each of modalities compared with surgical clips. Thus, in the setting of oncoplastic breast surgery, surgical clips should be routinely used for TB localisation. In view of the larger volumes of breast tissue excised and the extensive remodelling that are inherent to oncoplastic procedures, the concept of TB boost irradiation should be re-challenged.

Keywords

boost irradiationboost localisationbreast conservativegeographical missoncoplastic surgerysurgical clipstumour bed
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 18 , Issue 1 , March 2019 , pp. 63 - 69
Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Fawzy R, Lasheen S, Kamaleldin M, Wessam R, Khallaf E, Moussa M. (2019) Tumour bed localisation after oncoplastic breast conservative surgery: a comparative contouring study. Journal of Radiotherapy in Practice18: 63–69. doi: 10.1017/S1460396918000389

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