A computed tomography-based protocol vs conventional clinical mark-up for breast electron boost.

Full Abstract

AIMS:
Computed tomography planning of whole breast radiotherapy (WBRT) improves breast coverage and reduces the normal tissue dose. Computed tomography planning may increase tumour bed boost treatment accuracy. The aims of this investigation were (1) to compare the breast boost volume treated with clinical mark-up with the volume delineated with computed tomography planning and (2) to study tumour bed volume changes between the initial planning computed tomography scan and a second computed tomography scan at the time of breast boost mark-up.

MATERIALS AND METHODS:
Women receiving adjuvant WBRT and an electron boost after breast-conserving surgery were eligible. As per standard practice, WBRT was computed tomography planned while the boost electron portal was clinically defined. Electron field borders were then traced with wire and a second computed tomography scan was carried out in the boost treatment position. Post-surgical radiological abnormalities were contoured to create a tumour bed clinical target volume (CTV) on both scans (CTV1 and CTV2). A 1cm margin to CTV2 defined the planning target volume (PTV). The proportions of the CTV2 and PTV receiving 90% (V90) and 80% (V80) of the dose were calculated. Changes in volume between CTV1 and CTV2 were analysed.

RESULTS:
Data from 47 eligible patients were analysed. The mean V90 for the PTV was 61%. Lower electron energy (P<0.001) and small field sizes (P=0.004) were associated with a low V90. The mean CTV decreased by 4.3 cm3 (P=0.014) and was smaller in those with a long surgery to computed tomography interval (P=0.008). On average, the 90% isodose covered 61 cm3 of normal tissue.

CONCLUSIONS:
Conventional clinical breast boost planning is inaccurate. Electron boost computed tomography planning together with appropriate surgical clip placement and the use of mammograms and pathological information should provide optimal coverage of the tumour site. The boost could usually be planned from the initial computed tomography scan.

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Author information

Author/s: Bates, A T (AT); Swift, C-L (CL); Kwa, W (W); Moravan, V (V); Aquino-Parsons, C (C);

Affiliation: Department of Clinical Oncology, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK, and Department of Medical Physics, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada. andrew.bates1(-atsign-)virgin.net

Journal and publication information

Publication Type: Clinical Trial; Comparative Study; Journal Article

Journal: Clinical oncology (Royal College of Radiologists (Great Britain)) (Clin Oncol (R Coll Radiol)), published in England. (Language: eng)

Reference: 2007-Jun; vol 19 (issue 5) : pp 349-55

Dates: Created 2007/05/22; Completed 2007/08/14; Revised 2008/03/10;

PMID: 17379487, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Breast Neoplasms - radiotherapy
Carcinoma in Situ - radiotherapy
Electrons
Female
Humans

Middle Aged
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Adjuvant
Radiotherapy, Intensity-Modulated
Tomography, X-Ray Computed

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