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How to Boost the Breast Tumor Bed After Oncoplastic Surgical Procedure Using Surgical Clips and Image Registration?
S224
International Journal of Radiation Oncology Biology Physics
2016
management (mastectomy versus breast conserving therapy) was examined with respect to immunohistochemistry positivity by calculating the odds ratio and computing Pearson’s chi square test. A multiple logistic regression model was designed to adjust the association for potential confounding variables: age, tumor size, grade, ER/PR status, histology, gender, race, and year of diagnosis. Results: A total of 53,353 patients with a median age of 60.0 yrs were included in the analysis. A total of 30.4% of patients underwent mastectomy, with the remainder of cases treated with breast conserving therapy. A total of 4,097 (7.7%) cases represented clinically node negative disease with positive immunohistochemistry studies [N0IHC (+)]. The remaining clinically node negative cases (92.3%) had documented negative immunohistochemistry studies. In univariate analysis, IHC positivity was associated with choice of mastectomy over breast conserving therapy (OR [95% CI] Z 1.85 [1.73-1.97]; p < 0.001). After adjustment for potential confounding variables, IHC positivity was significantly associated with mastectomy versus breast conserving therapy in multivariate analysis (OR [95% CI] Z 1.62 [1.52-1.74]; p < 0.001). Conclusions: In clinically node negative breast cancer with negative H&E staining, the presence of isolated tumor cells by immunohistochemistry was associated with treatment by mastectomy relative to breast conserving therapy for local management. Further study is required to elucidate the therapeutic significance and implications of immunohistochemical positivity in clinically node negative breast cancer. Author Disclosure: T. Churilla: None. C.A. Peters: None.
How to Boost the Breast Tumor Bed After Oncoplastic Surgical Procedure Using Surgical Clips and Image Registration? E. Furet, N. Fournier-Bidoz, D. Peurien, V. Servois, F. Reyal, R. Dendale, F. Campana, A. Fourquet, and Y.M. Kirova; Institut Curie, Paris, France Purpose/Objective(s): To describe the procedure of definition of the breast boost volume using pre- and postoperative computed tomography (CT) imaging and surgical clips in the tumor bed after oncoplastic surgical procedure for breast cancer (BC) and to define the uniform institutional protocol for clips placement. Materials/Methods: Thirty-one consecutive BC patients (pts) who underwent simple tumorectomy or oncoplastic surgery with placement of one or more clips in the surgical cavity before breast remodeling have been studied. All of them underwent pre- and postoperative CT scan in treatment position. The 2 sets of images (pre-and post-surgical CT) were registered using a match-point registration and/or elastic fusion. During the surgery, 1 to 5 surgical clips were placed. The dimensions and orientation of surgical specimen were recorded. Three volumes are contoured: the GTV, the surgical specimen, and the region including all clips. The PTV included the clips region (clips CTV Z all clips with 0.5 cm margins), the gross tumor volume (GTV), and the surgical scar, with an overall margin of 5 mm in lateral and 10 mm in cranio-caudal directions, corresponding to localization and setup uncertainties. For each patient the clips CTV and GTV were delineated and the comparative analysis was realized. Results: Thirteen pts underwent simple tumorectomy and 18 oncoplastic surgery. Of them, there were 3 pts with 1, 4 with 2 clips, 4 with 3, 4 with 4, and 16 with 5 clips. The median GTV was 1.15 cc (range, 0.12-5.93); CTV clips ranged 0.50 to 23.45 cc. The volumetric analysis has shown that the intersection between GTV and CTV clips is significantly higher in patients with 3 and more clips, p Z 0,006 in the population of all pts. In the case of pts with oncoplastic surgery it was shown that more than 3 clips are needed to define the tumor bed volume with precision and the best intersection is obtained with 5 clips, p Z 0.02. The number of clips was directly related to the exact definition of the boost volume. Conclusions: The use of more than 3 clips associated with pre- to postoperative CT image registration allows better definition of the PTV boost volume. In case of an oncoplastic surgical procedure, the use of 5 clips is very helpful. The use of all information concerning the GTV, clips CTV is important and it is obligatory for patients who need high doses to breast tumor bed in order to optimize and reduce the boost volume and decrease the risk of recurrence and complications. Author Disclosure: E. Furet: None. N. Fournier-Bidoz: None. D. Peurien: None. V. Servois: None. F. Reyal: None. R. Dendale: None. F. Campana: None. A. Fourquet: None. Y.M. Kirova: None.
2017 Does Regional Micrometastatic Disease Influence Local Management in Breast Cancer? A SEER Database Analysis T. Churilla1 and C.A. Peters12; 1The Commonwealth Medical College, Scranton, PA, 2Northeast Radiation Oncology Center, Dunmore, PA Purpose/Objective(s): Isolated tumor cells, tumor clusters < 0.2 mm, in regional lymph nodes have uncertain prognostic and therapeutic significance in breast cancer. Isolated tumor cells may be detected via immunohistochemistry (IHC) studies in clinically negative patients with negative routine hematoxylin and eosin (H&E) staining. The primary objective of this study was to determine the effect of IHC positivity, micrometastatic disease, on the local management of clinically node negative breast cancer [N0IHC(+)]. Materials/Methods: The NCI Survival, Epidemiology, and End Results (SEER) database was queried for breast cancer cases from 2004-2008 that were staged as N0 with corresponding immunohistochemistry studies performed [N0IHC(+) versus N0IHC(-)]. Tumors less than 5 cm with no evidence of distant metastases were included in the analysis. Local
2018 Predictors of Metastatic Disease in Clinical T1 Node Negative Breast Cancer: A SEER Database Analysis T. Churilla1 and C.A. Peters12; 1The Commonwealth Medical College, Scranton, PA, 2Northeast Radiation Oncology Center, Dunmore, PA Purpose/Objective(s): Mechanisms of disease progression in breast cancer vary from theories of local-regional disease (Halsteadean) to theories of systemic disease (Fisher) at diagnosis. The presence of metastases with small primary tumors without axillary nodal involvement may represent a distinct phenotype of breast cancer that is systemic at the time of diagnosis. The purpose of this analysis was to determine if demographic or clinical variables were associated with metastatic disease in clinical T1, node negative breast cancer. Materials/Methods: The design was a case-control study. The NCI Survival, Epidemiology, and End Results (SEER) database was queried for breast cancer cases from 2004-2008 that were T1N0M1 and a random sample of T1N0M0 breast cancer cases served as a control. Demographic and clinical variables were tested for association with the presence of metastatic disease in these clinical T1N0 patients in univariate analyses. Significant univariate relationships were tested for association with casecontrol status (the presence/absence of metastatic disease) in multivariate analysis. Results: Five hundred eighty-nine clinical T1N0M1 breast cancer cases were included in the analysis and 600 T1N0M0 controls were randomly selected. The median age was 64 years. The majority of cases were infiltrating ductal carcinomas (68.7%), followed by lobular histology (16.9%), and the remainder of cases represented other histologies. A total of 75.9% and 62.8% of tumors expressed the estrogen, and progesterone receptors, respectively. With respect to race, 82.3% of patients were white, 9.3% were black, 7.0% were Asian, 0.8% were American Indian, and 0.5% were other. On univariate analysis, women less than 40 or greater than 80 years of age were more likely to present with M1 disease (OR [95%] Z 3.03 [1.31-7.03], 1.51 [1.04-2.17], respectively). Relative to well differentiated tumors, moderately differentiated (1.48 [1.09-2.01]) and poorly differentiated (2.13 [1.52-2.98]) tumors were associated with M1 status in a stepwise fashion. Lobular histology was associated with M1 disease (1.39 [1.02-1.90] relative to infiltrating ductal carcinoma. Hormone receptor negativity was associated with metastatic disease (ER Z 1.92
International Journal of Radiation Oncology Biology Physics
2016
management (mastectomy versus breast conserving therapy) was examined with respect to immunohistochemistry positivity by calculating the odds ratio and computing Pearson’s chi square test. A multiple logistic regression model was designed to adjust the association for potential confounding variables: age, tumor size, grade, ER/PR status, histology, gender, race, and year of diagnosis. Results: A total of 53,353 patients with a median age of 60.0 yrs were included in the analysis. A total of 30.4% of patients underwent mastectomy, with the remainder of cases treated with breast conserving therapy. A total of 4,097 (7.7%) cases represented clinically node negative disease with positive immunohistochemistry studies [N0IHC (+)]. The remaining clinically node negative cases (92.3%) had documented negative immunohistochemistry studies. In univariate analysis, IHC positivity was associated with choice of mastectomy over breast conserving therapy (OR [95% CI] Z 1.85 [1.73-1.97]; p < 0.001). After adjustment for potential confounding variables, IHC positivity was significantly associated with mastectomy versus breast conserving therapy in multivariate analysis (OR [95% CI] Z 1.62 [1.52-1.74]; p < 0.001). Conclusions: In clinically node negative breast cancer with negative H&E staining, the presence of isolated tumor cells by immunohistochemistry was associated with treatment by mastectomy relative to breast conserving therapy for local management. Further study is required to elucidate the therapeutic significance and implications of immunohistochemical positivity in clinically node negative breast cancer. Author Disclosure: T. Churilla: None. C.A. Peters: None.
How to Boost the Breast Tumor Bed After Oncoplastic Surgical Procedure Using Surgical Clips and Image Registration? E. Furet, N. Fournier-Bidoz, D. Peurien, V. Servois, F. Reyal, R. Dendale, F. Campana, A. Fourquet, and Y.M. Kirova; Institut Curie, Paris, France Purpose/Objective(s): To describe the procedure of definition of the breast boost volume using pre- and postoperative computed tomography (CT) imaging and surgical clips in the tumor bed after oncoplastic surgical procedure for breast cancer (BC) and to define the uniform institutional protocol for clips placement. Materials/Methods: Thirty-one consecutive BC patients (pts) who underwent simple tumorectomy or oncoplastic surgery with placement of one or more clips in the surgical cavity before breast remodeling have been studied. All of them underwent pre- and postoperative CT scan in treatment position. The 2 sets of images (pre-and post-surgical CT) were registered using a match-point registration and/or elastic fusion. During the surgery, 1 to 5 surgical clips were placed. The dimensions and orientation of surgical specimen were recorded. Three volumes are contoured: the GTV, the surgical specimen, and the region including all clips. The PTV included the clips region (clips CTV Z all clips with 0.5 cm margins), the gross tumor volume (GTV), and the surgical scar, with an overall margin of 5 mm in lateral and 10 mm in cranio-caudal directions, corresponding to localization and setup uncertainties. For each patient the clips CTV and GTV were delineated and the comparative analysis was realized. Results: Thirteen pts underwent simple tumorectomy and 18 oncoplastic surgery. Of them, there were 3 pts with 1, 4 with 2 clips, 4 with 3, 4 with 4, and 16 with 5 clips. The median GTV was 1.15 cc (range, 0.12-5.93); CTV clips ranged 0.50 to 23.45 cc. The volumetric analysis has shown that the intersection between GTV and CTV clips is significantly higher in patients with 3 and more clips, p Z 0,006 in the population of all pts. In the case of pts with oncoplastic surgery it was shown that more than 3 clips are needed to define the tumor bed volume with precision and the best intersection is obtained with 5 clips, p Z 0.02. The number of clips was directly related to the exact definition of the boost volume. Conclusions: The use of more than 3 clips associated with pre- to postoperative CT image registration allows better definition of the PTV boost volume. In case of an oncoplastic surgical procedure, the use of 5 clips is very helpful. The use of all information concerning the GTV, clips CTV is important and it is obligatory for patients who need high doses to breast tumor bed in order to optimize and reduce the boost volume and decrease the risk of recurrence and complications. Author Disclosure: E. Furet: None. N. Fournier-Bidoz: None. D. Peurien: None. V. Servois: None. F. Reyal: None. R. Dendale: None. F. Campana: None. A. Fourquet: None. Y.M. Kirova: None.
2017 Does Regional Micrometastatic Disease Influence Local Management in Breast Cancer? A SEER Database Analysis T. Churilla1 and C.A. Peters12; 1The Commonwealth Medical College, Scranton, PA, 2Northeast Radiation Oncology Center, Dunmore, PA Purpose/Objective(s): Isolated tumor cells, tumor clusters < 0.2 mm, in regional lymph nodes have uncertain prognostic and therapeutic significance in breast cancer. Isolated tumor cells may be detected via immunohistochemistry (IHC) studies in clinically negative patients with negative routine hematoxylin and eosin (H&E) staining. The primary objective of this study was to determine the effect of IHC positivity, micrometastatic disease, on the local management of clinically node negative breast cancer [N0IHC(+)]. Materials/Methods: The NCI Survival, Epidemiology, and End Results (SEER) database was queried for breast cancer cases from 2004-2008 that were staged as N0 with corresponding immunohistochemistry studies performed [N0IHC(+) versus N0IHC(-)]. Tumors less than 5 cm with no evidence of distant metastases were included in the analysis. Local
2018 Predictors of Metastatic Disease in Clinical T1 Node Negative Breast Cancer: A SEER Database Analysis T. Churilla1 and C.A. Peters12; 1The Commonwealth Medical College, Scranton, PA, 2Northeast Radiation Oncology Center, Dunmore, PA Purpose/Objective(s): Mechanisms of disease progression in breast cancer vary from theories of local-regional disease (Halsteadean) to theories of systemic disease (Fisher) at diagnosis. The presence of metastases with small primary tumors without axillary nodal involvement may represent a distinct phenotype of breast cancer that is systemic at the time of diagnosis. The purpose of this analysis was to determine if demographic or clinical variables were associated with metastatic disease in clinical T1, node negative breast cancer. Materials/Methods: The design was a case-control study. The NCI Survival, Epidemiology, and End Results (SEER) database was queried for breast cancer cases from 2004-2008 that were T1N0M1 and a random sample of T1N0M0 breast cancer cases served as a control. Demographic and clinical variables were tested for association with the presence of metastatic disease in these clinical T1N0 patients in univariate analyses. Significant univariate relationships were tested for association with casecontrol status (the presence/absence of metastatic disease) in multivariate analysis. Results: Five hundred eighty-nine clinical T1N0M1 breast cancer cases were included in the analysis and 600 T1N0M0 controls were randomly selected. The median age was 64 years. The majority of cases were infiltrating ductal carcinomas (68.7%), followed by lobular histology (16.9%), and the remainder of cases represented other histologies. A total of 75.9% and 62.8% of tumors expressed the estrogen, and progesterone receptors, respectively. With respect to race, 82.3% of patients were white, 9.3% were black, 7.0% were Asian, 0.8% were American Indian, and 0.5% were other. On univariate analysis, women less than 40 or greater than 80 years of age were more likely to present with M1 disease (OR [95%] Z 3.03 [1.31-7.03], 1.51 [1.04-2.17], respectively). Relative to well differentiated tumors, moderately differentiated (1.48 [1.09-2.01]) and poorly differentiated (2.13 [1.52-2.98]) tumors were associated with M1 status in a stepwise fashion. Lobular histology was associated with M1 disease (1.39 [1.02-1.90] relative to infiltrating ductal carcinoma. Hormone receptor negativity was associated with metastatic disease (ER Z 1.92