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Utility of CT imaging in a novel form of high‐dose‐rate intraoperative breast radiation therapy
Author(s) -
Hassinger Taryn E,
Showalter Timothy N,
Schroen Anneke T,
Brenin David R,
Berger Adam C,
Libby Bruce,
Showalter Shayna L
Publication year - 2018
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.12790
Subject(s) - medicine , intraoperative radiation therapy , radiology , brachytherapy , radiation therapy , breast conserving surgery , radiation treatment planning , dosimetry , nuclear medicine , biopsy , breast cancer , mastectomy , cancer
Intraoperative radiation therapy ( IORT ) is an alternative to whole breast radiation following breast conserving surgery. Conventional breast IORT is limited by lack of cross‐sectional imaging. In response, our institution developed Precision Breast IORT ( PB ‐ IORT ) which utilizes intraoperative computed tomography ( CT ) images for confirmation of brachytherapy applicator placement and for treatment planning. The purpose of this study was to determine the utility of CT imaging in PB ‐ IORT in the first 103 patients treated in two prospective clinical trials. Methods We retrospectively reviewed the first 103 patients treated with PB ‐ IORT . All patients underwent breast surgery and placement of a multi‐lumen brachytherapy applicator. Patients had a CT scan followed by high‐dose‐rate ( HDR ) brachytherapy. Endpoints were the number of patients having more than one CT during PB ‐ IORT and the number of treatment plans having image‐based modifications. Results After initial CT scan, 27 patients (26.2%) had findings prompting surgical applicator adjustment. One patient underwent an additional scan to localize a biopsy clip and aid in excision to negative margin. Eighty‐one patients (78.6%) had dosimetry modifications based on CT findings with 36 plans (35.0%) adjusted to protect the skin or chest wall and 45 plans (43.7%) to protect both the skin and chest wall. Conclusions Computed tomography findings prompted treatment alterations in the majority of patients treated with PB ‐ IORT to enhance tissue conformity and to sculpt the radiation dose away from normal tissues. CT imaging is unique to PB ‐ IORT . These findings suggest the potential clinical superiority of PB ‐ IORT given its allowance for patient‐specific alterations.