Impact of the Delineation Accuracy of Lumpectomy Cavity on Planning Target Volume in Partial-Breast Irradiation Using Brachytherapy and External-Beam Radiotherapy Cavity delineation for partial-breast irradiation

Main Article Content

Kazuhiko Sato https://orcid.org/0000-0002-0380-1693
Takahiro Shimo https://orcid.org/0000-0003-0151-3150
Nana Natsume https://orcid.org/0000-0002-9550-2518
Naoko Takeda https://orcid.org/0000-0002-0721-1842
Hiromi Fuchikami https://orcid.org/0000-0001-7126-7683
Masahiro Kato https://orcid.org/0000-0003-0612-703X
Tomohiko Okawa https://orcid.org/0000-0003-4443-9093

Keywords

breast cancer, lumpectomy, cavity, accuracy, radiotherapy, brachytherapy

Abstract

Background: In partial-breast irradiation (PBI), the accurate target volume delineation based on the lumpectomy cavity (LC) remained difficult due to uncertain LC identification. However, the impact of accurate LC delineation on the planning target volume (PTV) has not been investigated.


Materials and Methods: Between September 2018 and April 2020, 159 patients receiving perioperative PBI with multicather-interstitial brachytherapy have been evaluated. While LC delineated using implanted catheters as fiducial markers was used as a reference, conventional LC was virtually delineated on computed tomography with clips. PTV1-cm margin and PTV2-cm margin, which means 1cm and 2cm expansion from LC, were developed and assumed for brachytherapy and external-beam PBI, respectively. The target accuracy and the impact of the delineation accuracy of LC on PTVs were evaluated. The geographic miss index (GMI) and normal tissue index (NTI) were used as accuracy indices and were defined as the percentage of under- and overestimating volume, respectively.


Results: The PTV1-cm margin and PTV2-cm margin were significantly larger than the reference volume, 57.9cm3 vs. 37.9cm3 (P<0.001) and 113.2cm3 vs. 93.8cm3 (P<0.001), respectively. The GMI and NTI of LC were 27.3% and 41.2%, respectively. Although the GMI in the PTV1-cm margin and PTV2-cm margin was significantly reduced to 9.8% (P<0.0001) and 9.9% (P<0.0001), respectively, the NTI was not significantly improved in the PTV1-cm margin, which was 41.8% (P=0.60) but was improved in PTV2-cm margin, which was 23.1% (P<0.0001).


Conclusion: The GMI in PTV1-cm margin was reduced to be as low as PTV2-cm margin. Although PTV2-cm margin was associated with lower NTI, the absolute volume was almost double with PTV1-cm margin. Although further research was required, brachytherapy-based PBI may be a reasonable option to achieve tumor control and cosmesis using conventional delineation method.

References

1. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. 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. 2002;347(16):1233-1241. doi: 10.1056/nejmoa022152.
2. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer. N Engl J Med. 2002;347(16):1227-1232. doi: 10.1056/nejmoa020989.
3. Polgár C, Major T, Takácsi-Nagy Z, Fodor J. Breast-Conserving Surgery Followed by Partial or Whole Breast Irradiation: Twenty-Year Results of a Phase 3 Clinical Study. Int J Radiat Oncol Biol Phys. 2021;109(4):998-1006. doi: 10.1016/j.ijrobp.2020.11.006.
4. Strnad V, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: A randomised, phase 3, non-inferiority trial. Lancet. 2016;387(10015):229-238. doi: 10.1016/S0140-6736(15)00471-7.
5. Shah C, Badiyan S, Ben Wilkinson J, Vicini F, Beitsch P, Keisch M, et al. Treatment efficacy with accelerated partial breast irradiation (APBI): final analysis of the American Society of Breast Surgeons MammoSite(®) breast brachytherapy registry trial. Ann Surg Oncol. 2013;20(10):3279-3285. doi: 10.1245/s10434-013-3158-4.
6. Vicini FA, Cecchini RS, White JR, Arthur DW, Julian TB, Rabinovitch RA, et al. Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial. Lancet. 2019;394(10215):2155-2164. doi: 10.1016/S0140-6736(19)32514-0.
7. Whelan TJ, Julian JA, Berrang TS, Kim DH, Germain I, Nichol AM, et al. External beam accelerated partial breast irradiation versus whole breast irradiation after breast conserving surgery in women with ductal carcinoma in situ and node-negative breast cancer (RAPID): a randomised controlled trial. Lancet (London, England). 2019;394(10215):2165-2172. doi: 10.1016/S0140-6736(19)32515-2.
8. Meattini I, Marrazzo L, Saieva C, Desideri I, Scotti V, Simontacchi G, et al. Accelerated partial-breast irradiation compared with whole-breast irradiation for early breast cancer: Long-term results of the randomized phase III APBI-IMRT-florence trial. J Clin Oncol. 2020;38(35):4175-4183. doi: 10.1200/JCO.20.00650.
9. Vaidya JS, Bulsara M, Baum M, Wenz F, Massarut S, Pigorsch S, et al. Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial. BMJ. 2020;370:m2836. doi: 10.1136/bmj.m2836.
10. Orecchia R, Veronesi U, Maisonneuve P, Galimberti VE, Lazzari R, Veronesi P, et al. Intraoperative irradiation for early breast cancer (ELIOT): long-term recurrence and survival outcomes from a single-centre, randomised, phase 3 equivalence trial. Lancet Oncol. 2021;22(5):597-608. doi: 10.1016/S1470-2045(21)00080-2.
11. Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, et al. Accelerated Partial Breast Irradiation Consensus Statement From the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74(4):987-1001. doi: 10.1016/j.ijrobp.2009.02.031.
12. Strnad V, Krug D, Sedlmayer F, et al. DEGRO practical guideline for partial-breast irradiation. Strahlentherapie und Onkol. 2020;196(9):749-763. doi:10.1007/s00066-020-01613-z.
13. Viani GA, Arruda CV, Faustino AC, De Fendi LI. Partial-breast irradiation versus whole-breast radiotherapy for early breast cancer: A systematic review and update meta-analysis. Brachytherapy. 2020;19(4):491-498. doi: 10.1016/j.brachy.2020.03.003.
14. Shah C, Jia X, Hobbs BP, Tendulkar RD, Sittenfeld SMC, Al-Hilli Z, et al. Outcomes with Partial Breast Irradiation vs. Whole Breast Irradiation: a Meta-Analysis. Ann Surg Oncol. 2021;28(9):4985-4994. doi: 10.1245/s10434-020-09447-w.
15. Xiang X, Ding Z, Feng L, Li N. A meta-analysis of the efficacy and safety of accelerated partial breast irradiation versus whole-breast irradiation for early-stage breast cancer. Radiat Oncol. 2021;16(1):1-12. doi:10.1186/s13014-021-01752-2.
16. Yang TJ, Tao R, Elkhuizen PHM, van Vliet-Vroegindeweij C, Li G, Powell SN. Tumor bed delineation for external beam accelerated partial breast irradiation: a systematic review. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2013;108(2):181-189. doi: 10.1016/j.radonc.2013.05.028.
17. Sato K, Shimo T, Fuchikami H, Takeda N, Kato M, Okawa T. Catheter-based delineation of lumpectomy cavity for accurate target definition in partial-breast irradiation with multicatheter interstitial brachytherapy. J Contemp Brachytherapy. 2019;11(2):108-115. doi: 10.5114/jcb.2019.84504.
18. Sato K, Shimo T, Kato M, Natsume N, Fuchikami H, Takeda N, et al. Computed tomography-guided partial-breast brachytherapy using implanted catheters as fiducial markers versus co-registered magnetic resonance imaging. Brachytherapy. 2021;20(6):1219-1225. doi: 10.1016/j.brachy.2021.08.007.
19. Smitt MC, Birdwell RL, Goffinet DR. Breast electron boost planning: comparison of CT and US. Radiology. 2001;219(1):203-206. doi: 10.1148/radiology.219.1.r01ap34203.
20. Gee HE, Moses L, Stuart K, Nahar N, Tiver K, Wang T, et al. Contouring consensus guidelines in breast cancer radiotherapy: Comparison and systematic review of patterns of failure. J Med Imaging Radiat Oncol. 2019;63(1):102-115. doi: 10.1111/1754-9485.12804.
21. Sato K, Fuchikami H, Takeda N, Shimo T, Kato M, Okawa T. Moving incision for covert breast-conserving surgery may prevent early wound complications in brachytherapy-based partial-breast irradiation. Brachytherapy. 2019;18(5):645-650. doi: 10.1016/j.brachy.2019.05.002.
22. Sato K, Fuchikami H, Takeda N, Shimo T, Kato M, Okawa T. Efficacy of Single-Plane Implant Technique in Partial Breast Brachytherapy in Small-Breasted Patients. Int J Radiat Oncol Biol Phys. 2020;106(4):830-837. doi: 10.1016/j.ijrobp.2019.11.024.
23. Strnad V, Major T, Polgar C, Lotter M, Guinot JL, Gutierrez-Miguelez C, et al. ESTRO-ACROP guideline: Interstitial multi-catheter breast brachytherapy as Accelerated Partial Breast Irradiation alone or as boost – GEC-ESTRO Breast Cancer Working Group practical recommendations. Radiother Oncol. 2018;128(3):411-420. doi: 10.1016/j.radonc.2018.04.009.
24. Harrington KJ, Harrison M, Bayle P, Evans K, Dunn PA, Lambert HE, et al. Surgical clips in planning the electron boost in breast cancer: A qualitative and quantitative evaluation. Int J Radiat Oncol Biol Phys. 1996;34(3):579-584. doi: 10.1016/0360-3016(95)02090-X.
25. Ribeiro GG, Magee B, Swindell R, Harris M, Banerjee SS. The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol (R Coll Radiol). 1993;5(5):278-283. doi:10.1016/s0936-6555(05)80900-8
26. Fentiman IS, Poole C, Tong D, et al. Inadequacy of iridium implant as sole radiation treatment for operable breast cancer. Eur J Cancer. 1996;32A(4):608-611. doi:10.1016/0959-8049(95)00639-7
27. Mellon EA, Sreeraman R, Gebhardt BJ, Mierzejewski A, Correa CR. Impact of radiation treatment parameters and adjuvant systemic therapy on cosmetic outcomes after accelerated partial breast irradiation using 3-dimensional conformal radiation therapy technique. Pract Radiat Oncol. 2014;4(3):e159-e166. doi:10.1016/j.prro.2013.08.001
28. Sayan M, Hard D, Wilson K, Nelson C, Gagne H, Rubin D, et al. Long-term cosmesis following a novel schedule of accelerated partial breast radiation in selected early stage breast cancer: result of a prospective clinical trial. Radiat Oncol J. 2017;35(4):325-331. doi: 10.3857/roj.2017.00171.
29. Vicini FA, Remouchamps V, Wallace M, Sharpe M, Fayad J, Tyburski L, et al. Ongoing clinical experience utilizing 3D conformal external beam radiotherapy to deliver partial-breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2003;57(5):1247-1253. doi: 10.1016/s0360-3016(03)01573-6.
30. Hattangadi JA, Powell SN, MacDonald SM, Mauceri T, Ancukiewicz M, Freer P, et al. Accelerated partial breast irradiation with low-dose-rate interstitial implant brachytherapy after wide local excision: 12-year outcomes from a prospective trial. Int J Radiat Oncol Biol Phys. 2012;83(3):791-800. doi: 10.1016/j.ijrobp.2011.09.003.
31. Goldberg H, Prosnitz RG, Olson JA, Marks LB. Definition of postlumpectomy tumor bed for radiotherapy boost field planning: CT versus surgical clips. Int J Radiat Oncol Biol Phys. 2005;63(1):209-213. doi: 10.1016/j.ijrobp.2005.01.044.
32. Denham JW, Carter ML. Location of the excision site following segmental mastectomy for accurate postoperative irradiation. Aust N Z J Surg. 1986;56(9):685-688. doi: 10.1111/j.1445-2197.1986.tb02373.x.
33. Denham JW, Carter ML, Gill PG. Conservative treatment of breast cancer--where should the booster dose go? Int J Radiat Oncol Biol Phys. 1988;14(2):399-400. doi: 10.1016/0360-3016(88)90451-8.
34. Ebner F, de Gregorio N, Rempen A, Mohr P, de Gregorio A, Wöckel A, et al. To clip or not to clip the breast tumor bed? A retrospective look at the geographic miss index and normal tissue index of 110 patients with breast cancer. J Turkish Ger Gynecol Assoc. 2017;18(2):67-71. doi: 10.4274/jtgga.2016.0222.
35. Sadeghi A, Prestidge B, Lee J-M, Rosenthal A. Evaluation of the surface radiation dose and dose gradient in early stage breast cancer using high-dose-rate brachytherapy MammoSite applicator. Brachytherapy. 2006;5(4):230-234. doi:10.1016/j.brachy.2006.02.004.
36. Dzhugashvili M, Pichenot C, Dunant A, Balleyguier C, Delaloge S, Mathieu MC, et al. Surgical clips assist in the visualization of the lumpectomy cavity in three-dimensional conformal accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76(5):1320-1324. doi: 10.1016/j.ijrobp.2009.04.089.
37. Kaufman CS, Cross MJ, Barone JL, Dekhne NS, Devisetty K, Dilworth JT, et al. A Three-Dimensional Bioabsorbable Tissue Marker for Volume Replacement and Radiation Planning: A Multicenter Study of Surgical and Patient-Reported Outcomes for 818 Patients with Breast Cancer. Ann Surg Oncol. 2021;28(5):2529-2542. doi: 10.1245/s10434-020-09271-2.
38. Polgár C, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, et al. Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: 5-year resu. Lancet Oncol. 2017;18(2):259-268. doi: 10.1016/S1470-2045(17)30011-6.
39. Sato K, Shimo T, Fuchikami H, Takeda N, Kato M, Okawa T. Predicting adherence of dose-volume constraints for personalized partial-breast irradiation technique. Brachytherapy. 2021;20(1):163-170. doi: 10.1016/j.brachy.2020.06.018.

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