Zhang Aiping, Li Jianbin, Wang Wei, Wang Yongsheng, Mu Dianbin, Chen Zhaoqiu, Shao Qian, Li Fengxiang
aMedicine and Life Sciences College of Shandong Academy of Medical Sciences, Jinan University bDepartment of Radiation Oncology cBreast Cancer Center dDepartment of Pathology eDepartment of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
Medicine (Baltimore). 2017 Jan;96(2):e5839. doi: 10.1097/MD.0000000000005839.
The identification and contouring of target volume is important for breast-conserving therapy. The aim of the study was to compare preoperative magnetic resonance imaging (MRI), postoperative pathology, excised specimens' (ES) size, and tumor bed (TB) delineation as methods for determining the gross tumor volume (GTV) for radiotherapy after breast-conserving surgery (BCS).
Thirty-three patients with breast cancer who underwent preoperative MRI and radiotherapy after BCS were enrolled. The GTVs determined by MRI, pathology, and the ES were defined as GTVMRI, GTVPAT, and GTVES, respectively. GTVMRI+1 was defined as a 1.0-cm margin around the GTVMRI. The radiation oncologist delineated GTV of the TB (GTVTB) using planning computed tomography according to ≥5 surgical clips placed in the lumpectomy cavity (LC).
The median GTVMRI, GTVMRI+1, GTVPAT, GTVES, and GTVTB were 0.97 cm (range, 0.01-6.88), 12.58 cm (range, 3.90-34.13), 0.97 cm (range, 0.01-6.36), 15.46 cm (range, 1.15-70.69), and 19.24 cm (range, 4.72-54.33), respectively. There were no significant differences between GTVMRI and GTVPAT, GTVMRI+1 and GTVES, GTVES and GTVTB (P = 0.188, 0.070, and 0.264, respectively). GTVMRI is positively related with GTVPAT. However, neither GTVES nor GTVTB correlated with GTVMRI (P = 0.071 and 0.378, respectively). Furthermore, neither GTVES nor GTVTB correlated with GTVMRI+1 (P = 0.068 and 0.375, respectively).
When ≥5 surgical clips were placed in the LC for BCS, the volume of TB was consistent with the volume of ES. Neither the volume of TB nor the volume of ES correlated significantly with the volume of tumor defined by preoperative MRI.
靶区体积的识别和勾画对于保乳治疗很重要。本研究的目的是比较术前磁共振成像（MRI）、术后病理、切除标本（ES）大小和瘤床（TB）勾画，作为保乳手术（BCS）后放疗确定大体肿瘤体积（GTV）的方法。
纳入33例接受术前MRI和BCS后放疗的乳腺癌患者。由MRI、病理和ES确定的GTV分别定义为GTVMRI、GTVPAT和GTVES。GTVMRI+1定义为GTVMRI周围1.0 cm的边界。放射肿瘤学家根据放置在肿块切除腔（LC）中的≥5个手术夹，使用计划计算机断层扫描勾画TB的GTV（GTVTB）。
GTVMRI、GTVMRI+1、GTVPAT、GTVES和GTVTB的中位数分别为0.97 cm（范围0.01 - 6.88）、12.58 cm（范围3.90 - 34.13）、0.97 cm（范围0.01 - 6.36）、15.46 cm（范围1.15 - 70.69）和19.24 cm（范围4.72 - 54.33）。GTVMRI与GTVPAT、GTVMRI+1与GTVES、GTVES与GTVTB之间无显著差异（P分别为0.188、0.070和0.264）。GTVMRI与GTVPAT呈正相关。然而，GTVES和GTVTB均与GTVMRI无相关性（P分别为0.071和0.378）。此外，GTVES和GTVTB均与GTVMRI+1无相关性（P分别为0.068和0.375）。
当在BCS的LC中放置≥5个手术夹时，TB的体积与ES的体积一致。TB的体积和ES的体积均与术前MRI定义的肿瘤体积无显著相关性。
