Department of Radiation Oncology, Utrecht University Medical Center, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Breast Cancer Res Treat. 2011 Oct;129(3):857-65. doi: 10.1007/s10549-011-1696-7. Epub 2011 Aug 6.
In early-stage breast cancer and DCIS patients, breast-conserving therapy is today's standard of care. The purpose of this study was to evaluate the relation between the microscopic tumor diameter (mTD), the excised specimen (ES) volume, and the irradiated postoperative complex (POC) volume, in patients treated with breast-conserving therapy. In 186 patients with pTis-2N0 breast cancer, the mTDs, ES, and POC volumes (as delineated on the radiotherapy-planning CT scan), were retrospectively determined. Linear regression analysis was performed to study the association between the mTD, and the ES and POC volumes. The explained variance (r (2)) was calculated to establish the proportion of variation in the outcome variable that could be explained by the determinant (P ≤ 0.05). Moreover, the influence of tumor characteristics, age, surgical procedures, and breast size was studied. Median mTD was 1.2 cm (range 0.1-3.6 cm), median ES volume was 60 cm(3) (range 6-230 cm(3)) and median POC volume was 15 cm(3) (range 0.5-374 cm(3)). The POC was not clearly visible on the majority of the CT scans, based on a median assigned cavity visualization score of 3 (range 1-5). The explained variance for the mTD on the ES volume was low (r(2) = 0.08, P < 0.001). A slightly stronger association was observed in palpable tumors (r(2) = 0.23, P < 0.001) and invasive lobular carcinomas (r(2) = 0.39, P = 0.01). Furthermore, weak associations were observed between POC volume and mTD (r(2) = 0.04, P = 0.01), and POC and ES volume (r(2) = 0.23, P < 0.001). A weak association was observed between breast volume and ES volume (r(2) = 0.27, P < 0.001). In conclusion, both the excised and the irradiated POC volumes did not show a clinically relevant association with the mTD in women with early-stage breast cancer treated with breast-conserving therapy. Future studies should focus on improvement of surgical localization, development of image-guided, minimally invasive operation techniques, and more accurate image-guided target volume delineation in radiotherapy.
在早期乳腺癌和 DCIS 患者中，保乳治疗是目前的标准治疗方法。本研究的目的是评估保乳治疗患者的肿瘤微观直径（mTD）、切除标本（ES）体积和术后照射复杂体积（POC）之间的关系。在 186 例 pTis-2N0 乳腺癌患者中，回顾性确定了 mTDs、ES 和 POC 体积（在放射治疗计划 CT 扫描上划定）。进行线性回归分析以研究 mTD 与 ES 和 POC 体积之间的关联。计算解释方差（r (2)）以确定结果变量中可由决定因素解释的变化比例（P ≤ 0.05）。此外，还研究了肿瘤特征、年龄、手术程序和乳房大小的影响。中位 mTD 为 1.2cm（范围 0.1-3.6cm），中位 ES 体积为 60cm(3)（范围 6-230cm(3)），中位 POC 体积为 15cm(3)（范围 0.5-374cm(3)）。根据中位数分配的腔可视化评分 3（范围 1-5），大多数 CT 扫描上均未清晰显示 POC。mTD 与 ES 体积的解释方差较低（r(2) = 0.08，P < 0.001）。在可触及的肿瘤中观察到稍强的相关性（r(2) = 0.23，P < 0.001）和浸润性小叶癌（r(2) = 0.39，P = 0.01）。此外，还观察到 POC 体积与 mTD（r(2) = 0.04，P = 0.01）和 POC 与 ES 体积（r(2) = 0.23，P < 0.001）之间存在弱相关性。乳房体积与 ES 体积之间存在弱相关性（r(2) = 0.27，P < 0.001）。总之，在接受保乳治疗的早期乳腺癌女性中，切除的和照射的 POC 体积与 mTD 之间没有显示出具有临床意义的相关性。未来的研究应集中于提高手术定位、开发图像引导、微创操作技术以及放射治疗中更准确的图像引导靶区勾画。
