Acree Pascal, Kapadia Amee, Mahatme Ronak, Zhang Lucia, Patel Darsh, Almoney Charlie, Park Geonwoo, Kofsky Morgan, Matin Shababa, Habibi Mehran
Medical College of Georgia, Augusta University/University of Georgia Medical Partnership, Athens, Georgia.
Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
Adv Radiat Oncol. 2022 Jan 27;7(5):100848. doi: 10.1016/j.adro.2021.100848. eCollection 2022 Sep-Oct.
Of the 260,000 women diagnosed with breast cancer annually in the United States, more than 60% are treated with breast-conserving surgery or lumpectomy, followed by radiation to decrease the chance of local recurrence. More than 70% of breast cancer recurrences are localized to the original tumor cavity. Hence, targeted radiation therapy after lumpectomy is critical for recurrence prevention. With 30,000 patients annually opting for oncoplastic reconstruction of the breast after lumpectomy to improve cosmesis, the resulting tissue rearrangement increases the difficulty for radiation oncologists to accurately delineate the cavity when planning radiation therapy. Owing to the absence of a standardized protocol, it is important to assess the efficacy of various methods used to mark the tumor cavity for improved delineation.
A keyword search and analysis was used to compile relevant articles on PubMed (National Center for Biotechnology Information).
Currently, a common practice for tumor cavity localization is applying titanium surgical clips to the borders of lumpectomy cavity. Tissue movement and seroma formation both impact the positioning of surgical clips within the tumor cavity and lead to significant interobserver variability. Furthermore, the main application of surgical clips is to control the small vessels during surgery, and that can create confusion when the same clips are used for tumor bed localization. All alternative solutions present more precise tumor bed delineation but possess individual concerns with workflow integration, patient comfort, and accuracy. Though liquid-based fiducials were found to be the most effective for delineating tumor cavities, there are still drawbacks for clinical use.
These findings should encourage medical innovators to develop novel techniques for tumor cavity marking to increase delineation accuracy and effectively target at-risk tissue. Future solutions in this space should consider the properties of liquid-based fiducial markers to improve radiation oncologists' ability to precisely delineate the tumor cavity.
在美国，每年有260,000名女性被诊断出患有乳腺癌，其中超过60%的患者接受保乳手术或肿块切除术，随后进行放疗以降低局部复发的几率。超过70%的乳腺癌复发局限于原发肿瘤腔。因此，肿块切除术后的靶向放射治疗对于预防复发至关重要。每年有30,000名患者在肿块切除术后选择进行乳房肿瘤整形重建以改善美观效果，由此导致的组织重新排列增加了放射肿瘤学家在规划放射治疗时准确勾勒肿瘤腔的难度。由于缺乏标准化方案，评估用于标记肿瘤腔以改善勾勒效果的各种方法的有效性非常重要。
使用关键词搜索和分析在PubMed（美国国立生物技术信息中心）上汇编相关文章。
目前，肿瘤腔定位的常见做法是在肿块切除腔的边界处应用钛制手术夹。组织移动和血清肿形成都会影响手术夹在肿瘤腔内的位置，并导致观察者之间存在显著差异。此外，手术夹的主要用途是在手术期间控制小血管，当使用相同的夹子进行肿瘤床定位时可能会产生混淆。所有替代解决方案都能更精确地勾勒肿瘤床，但在工作流程整合、患者舒适度和准确性方面存在各自的问题。尽管发现基于液体的基准标记物在勾勒肿瘤腔方面最有效，但在临床应用中仍存在缺点。
这些发现应鼓励医学创新者开发用于肿瘤腔标记的新技术，以提高勾勒准确性并有效靶向高危组织。该领域未来的解决方案应考虑基于液体的基准标记物的特性，以提高放射肿瘤学家精确勾勒肿瘤腔的能力。
