Intraoperative breast radiation therapy with image guidance: Findings from CT images obtained in a prospective trial of intraoperative high-dose-rate brachytherapy with CT on rails

Daniel Trifiletti, Timothy N. Showalter, Bruce Libby, David R. Brenin, Anneke T. Schroen, Kelli A. Reardon, Shayna L. Showalter

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: Intraoperative radiation therapy (IORT) is an increasingly popular approach to breast conserving therapy in the treatment of early-stage breast cancer. A drawback to IORT compared with postoperative adjuvant radiation therapy is that it is not performed using image guidance. Our aim was to report on how our institution's unique IORT workflow integrates CT image guidance and how these CT images were used intraoperatively to change applicator positioning. Methods and Materials: We retrospectively reviewed the first 29 patients who participated in a prospective clinical trial of breast IORT at our institution. All patients underwent lumpectomy, multicatheter balloon placement, intraoperative CT scan, and high-dose-rate brachytherapy treatment delivery to 12.5 Gy to 1 cm from the balloon surface. This report focuses on the intraoperative CT findings that led to clinical changes, followed by repeat CT for IORT treatment planning. Results: After initial intraoperative CT, 7 patients underwent an additional intraoperative CT scan (24.1%). In 6 patients, the initial intraoperative CT scan identified large air cavities and/or poor tissue conformity. This defect could be improved in all patients with adjustment of the balloon applicator before planning and delivering IORT. Intraoperative CT scan was used in one patient to localize a biopsy clip and aided in excision to negative margin. Conclusions: In our study, intraoperative CT identifies actionable findings in breast IORT, including residual tumor or errors in applicator positioning, in almost 25% of patients. Clinical results of the described trial will serve to further validate this image-guided approach to IORT.

Original languageEnglish (US)
Pages (from-to)919-924
Number of pages6
JournalBrachytherapy
Volume14
Issue number6
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

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Brachytherapy
Breast
Radiotherapy
Segmental Mastectomy
Workflow
Residual Neoplasm
Therapeutics
Surgical Instruments
Air
Clinical Trials
Breast Neoplasms
Biopsy

Keywords

  • Breast cancer
  • CT
  • Intraoperative radiation therapy
  • Optimization

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Intraoperative breast radiation therapy with image guidance : Findings from CT images obtained in a prospective trial of intraoperative high-dose-rate brachytherapy with CT on rails. / Trifiletti, Daniel; Showalter, Timothy N.; Libby, Bruce; Brenin, David R.; Schroen, Anneke T.; Reardon, Kelli A.; Showalter, Shayna L.

In: Brachytherapy, Vol. 14, No. 6, 01.11.2015, p. 919-924.

Research output: Contribution to journalArticle

Trifiletti, Daniel ; Showalter, Timothy N. ; Libby, Bruce ; Brenin, David R. ; Schroen, Anneke T. ; Reardon, Kelli A. ; Showalter, Shayna L. / Intraoperative breast radiation therapy with image guidance : Findings from CT images obtained in a prospective trial of intraoperative high-dose-rate brachytherapy with CT on rails. In: Brachytherapy. 2015 ; Vol. 14, No. 6. pp. 919-924.
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abstract = "Purpose: Intraoperative radiation therapy (IORT) is an increasingly popular approach to breast conserving therapy in the treatment of early-stage breast cancer. A drawback to IORT compared with postoperative adjuvant radiation therapy is that it is not performed using image guidance. Our aim was to report on how our institution's unique IORT workflow integrates CT image guidance and how these CT images were used intraoperatively to change applicator positioning. Methods and Materials: We retrospectively reviewed the first 29 patients who participated in a prospective clinical trial of breast IORT at our institution. All patients underwent lumpectomy, multicatheter balloon placement, intraoperative CT scan, and high-dose-rate brachytherapy treatment delivery to 12.5 Gy to 1 cm from the balloon surface. This report focuses on the intraoperative CT findings that led to clinical changes, followed by repeat CT for IORT treatment planning. Results: After initial intraoperative CT, 7 patients underwent an additional intraoperative CT scan (24.1{\%}). In 6 patients, the initial intraoperative CT scan identified large air cavities and/or poor tissue conformity. This defect could be improved in all patients with adjustment of the balloon applicator before planning and delivering IORT. Intraoperative CT scan was used in one patient to localize a biopsy clip and aided in excision to negative margin. Conclusions: In our study, intraoperative CT identifies actionable findings in breast IORT, including residual tumor or errors in applicator positioning, in almost 25{\%} of patients. Clinical results of the described trial will serve to further validate this image-guided approach to IORT.",
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