Volume 62, Issue 6 pp. 835-840
Radiation Oncology—Original Article

Utility of CT imaging in a novel form of high-dose-rate intraoperative breast radiation therapy

Taryn E Hassinger

Taryn E Hassinger

Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA

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Timothy N Showalter

Timothy N Showalter

Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, USA

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Anneke T Schroen

Anneke T Schroen

Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA

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David R Brenin

David R Brenin

Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA

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Adam C Berger

Adam C Berger

Section of Surgical Oncology, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

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Bruce Libby

Bruce Libby

Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, USA

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Shayna L Showalter

Corresponding Author

Shayna L Showalter

Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA

Correspondence

Dr Shayna L Showalter, Division of Surgical Oncology, Department of Surgery, University of Virginia Health System, Box 800709, Charlottesville, VA 22908-0709, USA.

Email: [email protected]

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First published: 13 August 2018
Citations: 16
TE Hassinger MD, MS; TN Showalter MD, MPH; AT Schroen MD, MPH; DR Brenin MD; AC Berger MD; B Libby PhD; SL Showalter MD.
Conflict of interest: The authors declare no conflicts of interest.

Abstract

Introduction

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.

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