title: Dosimetric impact of post-operative seroma reduction during radiotherapy after breast-conserving surgery.
abstract: OBJECTIVE
  Three boost radiotherapy (RT) techniques were compared to evaluate the dosimetric effect of seroma reduction during RT after breast-conserving surgery (BCS).
  
  
  METHODS
  Twenty-one patients who developed seroma after BCS were included. Each patient underwent three CT scans: one week before RT (CT(-1)), in the third (CT(3)) and fifth (CT(5)) week of RT. For each patient, three plans were generated. (1) SEQ: whole breast irradiation planned on CT(-1,) sequential boost planned on CT(5), (2) SIB: simultaneous integrated boost planned on CT(-1), (3) SIB adaptive radiation therapy (SIB-ART): planned on CT(-1) and re-planned on CT(3). Irradiated volumes, mean lung (MLD) and maximum heart dose (HD(max)) were projected and compared on CT(5).
  
  
  RESULTS
  On average 62% seroma reduction during RT was observed. Volumes receiving ≥ 107% of prescribed whole breast dose were significantly smaller with SIB-ART compared to SEQ and SIB. The undesired volume receiving ≥ 95% of prescribed total dose was also significantly smaller with SIB-ART. For SEQ, SIB-ART and SIB, respectively, small but significant differences were found in MLD (4.2 vs. 4.6 vs. 4.7 Gy) and in HD(max) for patients with left-sided breast cancer (39.9 vs. 35.8 vs. 36.9 Gy).
  
  
  CONCLUSIONS
  This study demonstrates a dosimetric advantage for patients with seroma when simultaneous integrated boost is used with re-planning halfway through treatment.
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Tanja
authors.initials: T
authors.lastname: Alderliesten
authors.forename: Suzanne
authors.initials: S
authors.lastname: den Hollander
authors.forename: Tzu-I Jonathan
authors.initials: TJ
authors.lastname: Yang
authors.forename: Paula H M
authors.initials: PH
authors.lastname: Elkhuizen
authors.forename: Anke M
authors.initials: AM
authors.lastname: van Mourik
authors.forename: Coen
authors.initials: C
authors.lastname: Hurkmans
authors.forename: Peter
authors.initials: P
authors.lastname: Remeijer
authors.forename: Corine
authors.initials: C
authors.lastname: van Vliet-Vroegindeweij
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D049291:Seroma / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed