Koch Christine Anne, Corey Gemma, Liu Zhihui Amy, Han Kathy, Fyles Anthony
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Adv Radiat Oncol. 2021 Apr 20;6(4):100701. doi: 10.1016/j.adro.2021.100701. eCollection 2021 Jul-Aug.
Our purpose was to evaluate the usage and perceived benefit of surgical clips for breast radiation therapy planning in Canada, focusing on partial breast irradiation (PBI) after breast-conserving surgery.
A retrospective institutional review identified patients eligible for PBI based on clinicopathologic criteria, and tumor bed visualization was determined from computed tomography-planning scans. An online survey was subsequently distributed to Canadian radiation oncologists addressing the usage and added value of surgical clips for breast radiation therapy planning purposes. The survey also evaluated PBI usage and regimens. Responses were collected over a 4-week period. PBI regimen usage at our institution was also reviewed from May 1 to December 18, 2020.
Based on clinicopathologic criteria, 306 patients were identified between 2013 and 2018 who were eligible for PBI. However, only 24% (72/306) of cases were noted to have surgical clips, of which over 50% did not assist in tumor bed localization due to inconsistent clip positioning. Similarly, nearly two-thirds (28/43) of survey respondents indicated that surgical clips are placed in the tumor bed in less than 50% of cases. Almost all respondents (42/43) indicated that surgical clips facilitate breast radiation therapy planning and favor the development of guidelines to increase the consistent placement of surgical clips in the tumor bed after breast-conserving surgery. Approximately two-thirds of respondents (28/43) offer PBI to eligible patients as routine treatment, with moderate hypofractionated regimens most commonly recommended. However, the 1-week daily regimen of 26 Gy in 5 fractions is now offered to the majority (77%) of patients at our institution.
There was strong agreement among Canadian radiation oncologists that surgical clip placement facilitates breast radiation therapy planning, and most favor the development of surgical guidelines for the consistent placement of surgical clips in this setting. With the growing use of PBI, accurate localization of the tumor bed is extremely important.
我们的目的是评估加拿大乳腺放射治疗计划中手术夹的使用情况和感知益处，重点关注保乳手术后的部分乳腺照射（PBI）。
一项回顾性机构审查根据临床病理标准确定了符合PBI条件的患者，并通过计算机断层扫描计划扫描确定肿瘤床的可视化情况。随后向加拿大放射肿瘤学家发放了一份在线调查问卷，询问手术夹在乳腺放射治疗计划中的使用情况和附加价值。该调查还评估了PBI的使用情况和方案。在4周内收集了回复。我们还回顾了2020年5月1日至12月18日期间我们机构的PBI方案使用情况。
根据临床病理标准，2013年至2018年间确定了306例符合PBI条件的患者。然而，仅24%（72/306）的病例有手术夹，其中超过50%的病例因夹子位置不一致而无助于肿瘤床定位。同样，近三分之二（28/43）的调查受访者表示，不到50%的病例在肿瘤床放置了手术夹。几乎所有受访者（42/43）表示，手术夹有助于乳腺放射治疗计划，并赞成制定指南以增加保乳手术后手术夹在肿瘤床的一致放置。约三分之二的受访者（28/43）将PBI作为常规治疗提供给符合条件的患者，最常推荐的是中度低分割方案。然而，我们机构现在向大多数（77%）患者提供5次分割、每次26 Gy的1周每日方案。
加拿大放射肿瘤学家强烈一致认为，手术夹的放置有助于乳腺放射治疗计划，并且大多数人赞成制定在此情况下手术夹一致放置的手术指南。随着PBI的使用日益增加，肿瘤床的准确定位极为重要。
