Radiotherapy & Oncology
Volume 94, Issue 3 , Pages 292-299 , March 2010

How does knowledge of three-dimensional excision margins following breast conservation surgery impact upon clinical target volume definition for partial-breast radiotherapy?

  • Anna M. Kirby

      Affiliations

    • Department of Academic Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK
    • Corresponding Author InformationCorresponding author. Address: Department of Academic Radiotherapy, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK.
  • ,
  • Philip M. Evans

      Affiliations

    • Joint Department of Radiotherapy and Physics, Institute of Cancer Research, Sutton, UK
  • ,
  • Ashutosh Y. Nerurkar

      Affiliations

    • Department of Histopathology; and
  • ,
  • Saral S. Desai

      Affiliations

    • Department of Histopathology; and
  • ,
  • Jaroslaw Krupa

      Affiliations

    • Department of Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
  • ,
  • Haresh Devalia

      Affiliations

    • Department of Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
  • ,
  • Guidubaldo Querci della Rovere

      Affiliations

    • Department of Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
    • Mr Guidubaldo (Uccio) Querci della Rovere died peacefully in July 2009 after a long illness. The colleagues and friends with whom he collaborated wish to dedicate this manuscript to his memory.
  • ,
  • Emma J. Harris

      Affiliations

    • Joint Department of Radiotherapy and Physics, Institute of Cancer Research, Sutton, UK
  • ,
  • Julia Kyriakidou

      Affiliations

    • Joint Department of Radiotherapy and Physics, Institute of Cancer Research, Sutton, UK
  • ,
  • John R. Yarnold

      Affiliations

    • Department of Academic Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK
    • Joint Department of Radiotherapy and Physics, Institute of Cancer Research, Sutton, UK

Received 11 September 2009 ,Revised 5 November 2009 ,Accepted 10 November 2009.

References 

  1. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–2106
  2. Wolmark N, Curran WJ. On behalf of NSABP and RTOG of the American College of Radiology NSABP Protocol B-39. RTOG Protocol 0413. A randomized study phase III study of conventional whole breast irradiation versus partial breast irradiation for women with stage 0, I or II breast cancer. National surgical adjuvant breast and bowel project. March 13; 2007. p. 1–132.
  3. OCOG. Ontario Clinical Oncology Group, Canadian Institutes of Health Research, Canadian Breast Cancer Research Alliance. RAPID: randomized trial of accelerated partial breast irradiation; 2008. Available from: clinicaltrials.gov/ct2/show/NCT00282035.
  4. Available from: http://groups.eortc.be/radio/res/irma/synopsis_trial_irma1.pdf.
  5. Yarnold J, Coles C. On behalf of the IMPORT LOW Trial Management Group. Intensity Modulated and Partial Organ Radiotherapy. Randomised trial testing intensity modulated and partial organ radiotherapy following breast conservation surgery for early breast cancer. Trial Protocol, version 4. The Institute of Cancer Research, Sutton, Surrey, UK. p. 1–74.
  6. Danish Breast Cancer Co-operative Group. Partial breast versus whole breast irradiation in elderly women operated on for early breast cancer. Available from: clinicaltrials.gov/ct2/show/NCT00892814.
  7. Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985;56:979–990
  8. Hanbeukers B, Borger J, Van den Ende P, et al. Customized computed tomography-based boost volumes in breast-conserving therapy: use of three-dimensional histologic information for clinical target volume margins. Int J Radiat Oncol Biol Phys. 2009;75:757–763
  9. Coles CE, Wilson CB, Cumming J, et al. Titanium clip placement to allow accurate tumour bed localisation following breast conserving surgery: audit on behalf of the IMPORT Trial Management Group. Eur J Surg Oncol. 2009;35:578–582
  10. Landis DM, Luo W, Song J, et al. Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiat Oncol Biol Phys. 2007;67:1299–1308
  11. ICRU Report 62. Prescribing, recording and reporting photon beam therapy. Bethseda, MD; 1999.
  12. Gennaro M, Ferraris C, Guida V, Tomasic G, Carcangiu ML, Greco M. Conservative surgery in breast cancer. Significance of resection margins. Breast. 2001;10:432–437
  13. Mathers ME, Shrimankar J, Scott DJ, Charlton FG, Griffith CD, Angus B. The use of a standard proforma in breast cancer reporting. J Clin Pathol. 2001;54:809–811
  14. Faverly DR, Hendriks JH, Holland R. Breast carcinomas of limited extent: frequency, radiologic–pathologic characteristics, and surgical margin requirements. Cancer. 2001;91:647–659
  15. Stroom J, Schlief A, Alderliesten T, Peterse H, Bartelink H, Gilhuijs K. Using histopathology breast cancer data to reduce clinical target volume margins at radiotherapy. Int J Radiat Oncol Biol Phys. 2009;74:898–905
  16. Vicini FA, Kestin LL, Goldstein NS. Defining the clinical target volume for patients with early-stage breast cancer treated with lumpectomy and accelerated partial breast irradiation: a pathologic analysis. Int J Radiat Oncol Biol Phys. 2004;60:722–730
  17. Mannino M, Yarnold J. Accelerated partial breast irradiation trials: diversity in rationale and design. Radiother Oncol. 2009;91:16–22
  18. Goldstein NS, Kestin LJ, Vicini FA. Monomorphic epithelial proliferations: characterization and evidence suggesting they are the pool of partially transformed lesions from which some invasive carcinomas arise. Am J Clin Pathol. 2007;128:1023–1034
  19. Belletti B, Vaidya JS, D’Andrea S, et al. Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res. 2008;14:1325–1332
  20. Vaidya JS, Baum M, Tobias JS, et al. Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer. Ann Oncol. 2001;12:1075–1080
  21. Vicini FA, Remouchamps V, Wallace M, et al. Ongoing clinical experience utilizing 3D conformal external beam radiotherapy to deliver partial-breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2003;57:1247–1253
  22. Kass R, Kumar G, Klimberg VS, et al. Clip migration in stereotactic biopsy. Am J Surg. 2002;184:325–331
  23. Weed DW, Yan D, Martinez AA, Vicini FA, Wilkinson TJ, Wong J. The validity of surgical clips as a radiographic surrogate for the lumpectomy cavity in image-guided accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2004;60:484–492
  24. Gardner ES, Sumner WT, Cook JL. Predictable tissue shrinkage during frozen section histopathologic processing for Mohs micrographic surgery. Dermatol Surg. 2001;27:813–818

PII: S0167-8140(09)00614-8

doi: 10.1016/j.radonc.2009.11.002

Radiotherapy & Oncology
Volume 94, Issue 3 , Pages 292-299 , March 2010