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The Influence of Treatment Position (Prone vs. Supine) on Clip Displacement, Seroma, Tumor Bed and Partial Breast Target Volumes: Comparative Study

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Pathology & Oncology Research

Abstract

To analyse the displacement of surgical clips in prone (Pr) position and assess the consequences on target volumes and integral dose of partial breast irradiation (PBI). 30 post-lumpectomy breast cancer patients underwent CT imaging in supine (Su) and Pr. Clip displacements were measured by the distances from the clips to a common fix bony reference point. On each dataset, the tumour bed (TB = clips ± seroma), clinical target volume (CTV = TB + 1.5 cm) and planning target volumes (PTV = CTV + 1 cm) for PBI were determined and the volume pairs were compared. Furthermore estimation of integral dose ratio (IDR) within the breast from tangential treatment was performed as the ratio of the irradiated breast volume and the volume encompassing all clips. Clips close to the chest wall (CW) in Su showed significantly less displacement in Pr. The mean volumes of seroma, CTV and PTV were significantly higher in Pr than in Su. The PTV volume difference (Pr-Su) was significantly higher in patients with presence of seroma, deep clips and TB location in the superior-internal-quadrant (SIQ) and at the junction of superior quadrants (jSQ). In a multivariate analysis two factors remained significant: seroma and TB localization in SIQ-jSQ. The IDR was significantly larger in Su than in Pr (7.6 vs. 4.1 p < 0.01). Clip displacements varied considerably with respect to their relative position to the CW. In selected patients Pr position potentially leads to a significant increase in target volumes of PBI. Tangential beam arrangement for PBI should be avoided, not only in Su but in Pr as well in case of clip-based target volume definition.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital of Liège, Domain University of Sart Tilman, B.35, B-4000, Liège 1, Belgium

    Ferenc Lakosi, Akos Gulyban, Selma Ben-Mustapha Simoni, Paul Viet Nguyen, Séverine Cucchiaro, Sophie Nicolas & Philippe Coucke

  2. Department of Biostatistics, University Hospital of Liège, Liège, Belgium

    Laurence Seidel

  3. Department of Radiation Oncology, Debrecen University, Debrecen, Hungary

    Levente Janvary

  4. Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada

    Peter Vavassis

Authors
  1. Ferenc Lakosi
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  2. Akos Gulyban
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  3. Selma Ben-Mustapha Simoni
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  4. Paul Viet Nguyen
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  5. Séverine Cucchiaro
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  6. Laurence Seidel
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  7. Levente Janvary
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  8. Sophie Nicolas
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  9. Peter Vavassis
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  10. Philippe Coucke
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Correspondence to Ferenc Lakosi.

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Lakosi, F., Gulyban, A., Simoni, S.BM. et al. The Influence of Treatment Position (Prone vs. Supine) on Clip Displacement, Seroma, Tumor Bed and Partial Breast Target Volumes: Comparative Study. Pathol. Oncol. Res. 22, 493–500 (2016). https://doi.org/10.1007/s12253-015-0028-3

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  • DOI: https://doi.org/10.1007/s12253-015-0028-3

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