title: [Breast-conserving surgery and irradiation for early breast cancer: value of surgical clips in the surgical cavity].
abstract: OBJECTIVE
  To evaluate, qualitatively and quantitatively, the role of surgical clips in planning the tumor bed electron or brachytherapy boost in patients undergoing breast-conserving surgery and radiotherapy.
  
  
  METHODS
  In 60 patients with breast cancer stage I or II, the excision cavity boundaries were marked by clips at surgery. Patients received a boost with brachytherapy (n = 51) or electron beam (n = 9) after whole breast irradiation. The boost target volume was first planned using clinical, mammography and operative information and its accuracy evaluated by screening the surgical clips and, if necessary, adjusting the field to encompass all clips and to include the scar. Dosimetry was retrospectively performed for each brachytherapy patient and for each surgical clip.
  
  
  RESULTS
  It was necessary to modify the target volume field in 11 cases (18%). The average dose received by the surgical clips was 116.1% of the dose delivered to the reference isodose (median: 101.75%, range: 16-457%). However, dose heterogeneity was important in the same patient and between patients.
  
  
  CONCLUSIONS
  Delineation of the boost target volume with surgical clips is more accurate than with clinical landmarks alone but this technique does not allow measurements of the clip-chest wall and clip-skin distances. Virtual simulation with CT-scan cuts is recommended for optimising boost planning.
authors.affiliation: Service d'oncologie-radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Deniaud-Alexandre
authors.forename: E
authors.initials: E
authors.lastname: Touboul
authors.forename: J P
authors.initials: JP
authors.lastname: Lefranc
authors.forename: J
authors.initials: J
authors.lastname: Rolland
authors.forename: L
authors.initials: L
authors.lastname: Lin
authors.forename: L F
authors.initials: LF
authors.lastname: Julia
authors.forename: K
authors.initials: K
authors.lastname: Keraudy
authors.forename: J N
authors.initials: JN
authors.lastname: Foulquier
mesh_terms: D001918:Brachytherapy; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D013525:Surgical Instruments; D016896:Treatment Outcome