Impact of a Novel Bioabsorbable Implant on Radiation Treatment Planning for Breast Cancer
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Techniques for accurately delineating the tumor bed after breast-conserving surgery (BCS) can be challenging. As a result, the accuracy, and efficiency of radiation treatment (RT) planning can be negatively impacted. Surgically placed clips or the post-surgical seroma are commonly used to determine target volume; however, these methods can lead to a high degree of uncertainty and variability. A novel 3-dimensional bioabsorbable marker was used during BCS and assessed for its impact on RT planning.
One hundred and ten implants were sutured to the margins of the tumor bed excision site in 108 patients undergoing BCS. Routine CT imaging of the breast tissue was performed for RT planning, and the marker was assessed for visibility and utility in target delineation. RT regimens, target volumes and associated treatment costs were analyzed.
In all patients, the marker was easily visible and in 95.7 % of cases, it proved useful for RT planning. 36.8 % of patients received conventional whole breast irradiation plus boost, 56.6 % received hypo-fractionation plus boost, and 6.6 % received accelerated partial breast irradiation. A shift toward increased use of hypo-fractionated regimens was noted over the three year period of this study. There were no device-related complications or cancer recurrences in this group of patients.
This study demonstrated the use of a novel 3-dimensional marker as a safe and effective method for delineating the tumor bed with a significant utility for RT planning. With routine use of the device, an increased use of hypofractionation with a resultant 25 % cost savings was noted.
KeywordsAccelerate Partial Breast Irradiation Radiation Therapy Planning Reduction Mammoplasty Whole Breast Irradiation Tissue Flap
Dr. Lebovic is a consultant for Focal Therapeutics, Inc., Aliso Viejo, California.
Compliance with ethical standards
Conflicts of interest
There are no conflicts of interest to disclose.
- 2.Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) 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 347:1233–1241CrossRefPubMedGoogle Scholar
- 8.Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S et al (2014) Society of Surgical Oncology—American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol 21:704–716CrossRefPubMedGoogle Scholar
- 9.Bekelman JE, Sylwestrzak G, Barron J, Liu J, Epstein AJ, Freedman G, Malin J, Emanuel EJ (2014) Uptake and costs of hypofractionated vs conventional whole breast irradiation after breast conserving surgery in the United States, 2008–2013. JAMA 312(23):2542–2550CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Vicini FA (2005) A randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer. Radiation Therapy Oncology Group, Philadelphia, PA, protocol #0413Google Scholar
- 12.Scanderberg D (2010) Yashar C, White G, Rice R, Pawlicki T. Evaluation of three APBI techniques under NSABP B-39 guidelines. J Appl Clin Med Phys 11(1):274–280Google Scholar
- 13.Livi Lorenzo, Meattini I, Marrazzo L, Simontacchi G, Pallotta S, Saieva C, Paiar F et al (2015) Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomized controlled trial. Eur J Cancer 51:451–463CrossRefPubMedGoogle Scholar
- 19.Chafe S, Moughan J, McCormick B, Wong J, Pass H, Rabinovitch R, Arthur DW et al (2013) Late Toxicity and patient self-assessment of breast appearance/satisfaction on RTOG 0319: A Phase 2 trial of 3-dimensional conformal radiation therapy—accelerated partial breast irradiation following lumpectomy for stages I and II breast cancer. Int J Rad Onc Biol Phys 86(5):854–859CrossRefGoogle Scholar
- 23.Hanbeukers B, van den Ende P, van der Ent F, Houben R, Jager J, Keymeulen K, Murrer L, Sastrowijoto S, van de Vijver K, Boersma L (2009) Customized computed tomography-based boost volumes in breast-conserving therapy: use of three-dimensional histologic information for clinical target volume margins. Int J Radiat Oncol Biol Phys 75(3):757–763CrossRefPubMedGoogle Scholar
- 28.Kirby AM, Yarnold JR, Evans PM, Morgan VA, Schmidt MA, Scurr ED, Desouza NM (2009) Tumor bed delineation for partial breast and breast boost radiotherapy planned in the prone position: what does MRI add to X-ray CT localization of titanium clips placed in the excision cavity wall? Int J Radiat Oncol Biol Phys 74(4):1276–1282CrossRefPubMedGoogle Scholar
- 30.Kirby AM, Evans PM, Nerukar AY, Desai SS, Krupa J, Devalia H, della Rovere GQ, Harris EJ, Kyriakidou J, Yarnold JR (2010) How does knowledge of three-dimensional excision margins following breast conservation surgery impact upon clinical target volume definition for partial breast radiotherapy? Radiother Oncol 94(3):292–299CrossRefPubMedGoogle Scholar
- 32.Smith LA, Kuske RR, Cross MJ (2014) Improved targeting of the lumpectomy cavity using a spiral 3-dimensional marker. Poster presentation; Am Soc Ther Rad Onc (ASTRO), San Francisco, October, (2014)Google Scholar
- 33.Harman J, Govender S, Benjamin B, Simpson J (2014) Poster presentation; An improved method for marking the surgical cavity during partial mastectomy. Royal Aust New Zealand Conf Clin Radiol (RANZCR), Auckland, October, (2014)Google Scholar
- 34.Kaufman CS, Hall W, Hill L, Caro R, Nix S, Evans E, Zacharias K et al (2015) Poster presentation; Initial experience with a novel 3-dimensional bioabsorbable lumpectomy marker. Am Soc of Breast Surgeons, Orlando, AprilGoogle Scholar
- 37.Rabinovitch R, Finlayson C, Pan Z, Lewin J, Humphries S, Biffi W, Francoise R (2000) Radiographic evaluation of surgical clips is better than ultrasound for defining the lumpectomy cavity in breast boost treatment planning: a prospective clinical study. Int J Radiat Oncol Biol Phys 47(2):313–317CrossRefPubMedGoogle Scholar
- 40.Coles CE, Wilson CB, Cumming J, Benson JR, Forouhi P, Wilkinson JS, Jena R, Wishart GC (2009) Titanium clip placement to allow accurate tumour bed localization following breast conserving surgery: audit on behalf on the IMPORT Trial Management Group. Eur J Surg Oncol 35(6):578–582CrossRefPubMedGoogle Scholar
- 42.Coles CE, Harris EJ, Donovan EM, Bliss P, Evans PM, Fairfoul J, Mackenzie C, Rawlings C et al (2011) Evaluation of implanted gold seeds for breast radiotherapy planning and on treatment verification: a feasibility study on behalf of the IMPORT trialists. Radiother Oncol 100:276–281CrossRefPubMedGoogle Scholar
- 44.Kirby AM, Evans PM, Nerurkar AY, Desai SS, Krupa J, Devalia H, della Rovere GQ et al (2010) How does knowledge of three-dimensional excision margins following breast conservation surgery impact upon clinical target volume definition for partial-breast radiotherapy? Radiother Oncol 94:292–299CrossRefPubMedGoogle Scholar