Ebner Florian, de Gregorio Nikolaus, Rempen Andreas, Mohr Peter, de Gregorio Amelie, Wöckel Achim, Janni Wolfgang, Witucki Gerlo
Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany.
Department of Obstetrics and Gynecology, Diakonie-Klinikum Schwäbisch Hall, Women's Clinic with Breast Center and Genital Cancer Center, Schwäbisch Hall, Germany.
J Turk Ger Gynecol Assoc. 2017 Jun 1;18(2):67-71. doi: 10.4274/jtgga.2016.0222. Epub 2017 Feb 7.
Planning of breast radiation for patients with breast conserving surgery often relies on clinical markers such as scars. Lately, surgical clips have been used to identify the tumor location. The purpose of this study was to evaluate the geographic miss index (GMI) and the normal tissue index (NTI) for the electron boost in breast cancer treatment plans with and without surgical clips.
A retrospective descriptive study of 110 consecutive post-surgical patients who underwent breast-conserving treatment in early breast cancer, in which the clinical treatment field with the radiologic (clipped) field were compared and GMI/NTI for the electron boost were calculated respectively.
The average clinical field was 100 mm (range, 100-120 mm) and the clipped field was 90 mm (range, 80-100 mm). The average GMI was 11.3% (range, 0-44%), and the average NTI was 27.5% (range, 0-54%). The GMI and NTI were reduced through the use of intra-surgically placed clips.
The impact of local tumor control on the survival of patients with breast cancer is also influenced by the precision of radiotherapy. Additionally, patients demand an appealing cosmetic result. This makes "clinical" markers such as scars unreliable for radiotherapy planning. A simple way of identifying the tissue at risk is by intra-surgical clipping of the tumor bed. Our results show that the use of surgical clips can reduce the diameter of the radiotherapy field and increase the accuracy of radiotherapy planning. With the placement of surgical clips, more tissue at risk is included in the radiotherapy field. Less normal tissue receives radiotherapy with the use of surgical clips.
保乳手术患者的乳腺放疗计划通常依赖于诸如瘢痕等临床标记物。最近，手术夹已被用于确定肿瘤位置。本研究的目的是评估在有和没有手术夹的乳腺癌治疗计划中，电子束加量放疗的靶区遗漏指数（GMI）和正常组织指数（NTI）。
对110例连续接受早期乳腺癌保乳治疗的术后患者进行回顾性描述性研究，比较临床治疗野与放射学（夹闭）野，并分别计算电子束加量放疗的GMI/NTI。
临床野平均为100 mm（范围100 - 120 mm），夹闭野平均为90 mm（范围80 - 100 mm）。平均GMI为11.3%（范围0 - 44%），平均NTI为27.5%（范围0 - 54%）。通过使用术中放置的夹子，GMI和NTI降低。
局部肿瘤控制对乳腺癌患者生存的影响也受放疗精度的影响。此外，患者要求有良好的美容效果。这使得诸如瘢痕等“临床”标记物在放疗计划中不可靠。识别危险组织的一种简单方法是术中对瘤床进行夹闭。我们的结果表明，使用手术夹可减小放疗野直径并提高放疗计划的准确性。通过放置手术夹，更多的危险组织被纳入放疗野。使用手术夹时，接受放疗的正常组织减少。
