Planning the breast tumor bed boost: Changes in the excision cavity volume and surgical scar location after breast-conserving surgery and whole-breast irradiation

Kevin S. Oh, Feng Ming Kong, Kent A. Griffith, Beth Yanke, Lori J. Pierce

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Purpose: The aims of this study were to determine the changes in breast and excision cavity volumes after whole-breast irradiation and the adequacy of using the surgical scar to guide boost planning. Methods and Materials: A total of 30 women consecutively treated for 31 breast cancers were included in this study. Simulation CT scans were performed before and after whole-breast irradiation. CT breast volumes were delineated using clinically defined borders. Excision cavity volumes were contoured based on surgical clips, the presence of a hematoma, and/or other surgical changes. Hypothetical electron boost plans were generated using the surgical scar with a 3-cm margin and analyzed for coverage. Results: The mean CT breast volumes were 774 and 761 cc (p = 0.22), and the excision cavity volumes were 32.1 and 25.1 cc (p < 0.0001), before and after 40 Gy (39-42 Gy) of whole-breast irradiation, respectively. The volume reduction in the excision cavity was inversely correlated with time elapsed since surgery (R = 0.46, p < 0.01) and body weight (R = 0.50, p < 0.01). The scar-guided hypothetical plans failed to cover the excision cavity adequately in 62% and 53.8% of cases using the pretreatment and postradiation CTs, respectively. Per the hypothetical plans, the minimum dose to the excision cavity was significantly lower for tumors located in the inner vs. outer quadrants (p = 0.02) and for cavities >20 cc vs. <20 cc (p = 0.01). Conclusions: This study demonstrates a significant reduction in the volume of the excision cavity during whole-breast irradiation. Scar-guided boost plans provide inadequate coverage of the excision cavity in the majority of cases.

Original languageEnglish (US)
Pages (from-to)680-686
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume66
Issue number3
DOIs
StatePublished - Nov 1 2006

Fingerprint

scars
Segmental Mastectomy
acceleration (physics)
surgery
breast
Cicatrix
planning
beds
Breast
tumors
Breast Neoplasms
cavities
irradiation
Cone-Beam Computed Tomography
clips
adequacy
Surgical Instruments
Hematoma
borders
margins

Keywords

  • Boost
  • Breast cancer
  • Excision cavity
  • Radiotherapy
  • Surgical scar

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Planning the breast tumor bed boost : Changes in the excision cavity volume and surgical scar location after breast-conserving surgery and whole-breast irradiation. / Oh, Kevin S.; Kong, Feng Ming; Griffith, Kent A.; Yanke, Beth; Pierce, Lori J.

In: International Journal of Radiation Oncology Biology Physics, Vol. 66, No. 3, 01.11.2006, p. 680-686.

Research output: Contribution to journalArticle

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