title: Excised and irradiated volumes in relation to the tumor size in breast-conserving therapy.
abstract: In early-stage breast cancer and DCIS patients, breast-conserving therapy is today's standard of care. The purpose of this study was to evaluate the relation between the microscopic tumor diameter (mTD), the excised specimen (ES) volume, and the irradiated postoperative complex (POC) volume, in patients treated with breast-conserving therapy. In 186 patients with pTis-2N0 breast cancer, the mTDs, ES, and POC volumes (as delineated on the radiotherapy-planning CT scan), were retrospectively determined. Linear regression analysis was performed to study the association between the mTD, and the ES and POC volumes. The explained variance (r (2)) was calculated to establish the proportion of variation in the outcome variable that could be explained by the determinant (P ≤ 0.05). Moreover, the influence of tumor characteristics, age, surgical procedures, and breast size was studied. Median mTD was 1.2 cm (range 0.1-3.6 cm), median ES volume was 60 cm(3) (range 6-230 cm(3)) and median POC volume was 15 cm(3) (range 0.5-374 cm(3)). The POC was not clearly visible on the majority of the CT scans, based on a median assigned cavity visualization score of 3 (range 1-5). The explained variance for the mTD on the ES volume was low (r(2) = 0.08, P < 0.001). A slightly stronger association was observed in palpable tumors (r(2) = 0.23, P < 0.001) and invasive lobular carcinomas (r(2) = 0.39, P = 0.01). Furthermore, weak associations were observed between POC volume and mTD (r(2) = 0.04, P = 0.01), and POC and ES volume (r(2) = 0.23, P < 0.001). A weak association was observed between breast volume and ES volume (r(2) = 0.27, P < 0.001). In conclusion, both the excised and the irradiated POC volumes did not show a clinically relevant association with the mTD in women with early-stage breast cancer treated with breast-conserving therapy. Future studies should focus on improvement of surgical localization, development of image-guided, minimally invasive operation techniques, and more accurate image-guided target volume delineation in radiotherapy.
authors.affiliation: Department of Radiation Oncology, Utrecht University Medical Center, PO Box 85500, 3508 GA Utrecht, The Netherlands. M.denHartogh-3@umcutrecht.nl
authors.forename: M D
authors.initials: MD
authors.lastname: den Hartogh
authors.forename: B
authors.initials: B
authors.lastname: van Asselen
authors.forename: E M
authors.initials: EM
authors.lastname: Monninkhof
authors.forename: M A A J
authors.initials: MA
authors.lastname: van den Bosch
authors.forename: M
authors.initials: M
authors.lastname: van Vulpen
authors.forename: P J
authors.initials: PJ
authors.lastname: van Diest
authors.forename: K G A
authors.initials: KG
authors.lastname: Gilhuijs
authors.forename: A J
authors.initials: AJ
authors.lastname: Witkamp
authors.forename: L
authors.initials: L
authors.lastname: van de Bunt
authors.forename: W P T M
authors.initials: WP
authors.lastname: Mali
authors.forename: H J G D
authors.initials: HJ
authors.lastname: van den Bongard
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012044:Regression Analysis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult