title: Focus on the actual clinical target volume irradiated with intraoperative radiotherapy for breast cancer.
abstract: OBJECTIVE
  Intraoperative radiotherapy (IORT) has been investigated as an exclusive adjuvant treatment option for early-stage breast cancer (BC). We analysed our experience on the technical aspects of this innovative approach in terms of identification of breast volume actually to be treated during IORT.
  
  
  METHODS
  A total of 315 patients at low risk of breast cancer recurrence underwent IORT as exclusive treatment after breast-conservative surgery. To evaluate the breast volume actually irradiated with IORT, we considered a sample of eight patients, chosen retrospectively as having enough clips to identify the tumour bed and IORT site in computed-tomography (CT). The clinical target volume (CTV) was assessed for each patient with two different methods: the first, cc-IORT, was considered during surgery according to the chosen collimator diameter and glandular thickness, while the second, cc-CT, was evaluated through computed-tomography performed after surgery. The cc-CT CTV was obtained by contouring the cc-IORT on the CT section on the basis of the clips placed by the surgeon on the resection margins.
  
  
  RESULTS
  In our experience, the 5-cm (50%) and the 6-cm (36%) diameter collimators have been the ones, used the most. The diameter of the collimator used did not appear to adversely affect the satisfactory aesthetic result. The comparison between CTVs showed that glandular breast volume contoured with CT (cc-CT) appeared to be three fold larger than the target identified at surgery and included in the area of chosen collimator (cc-IORT).
  
  
  CONCLUSIONS
  The actual volume of breast gland irradiated with the IORT procedure appears to be larger than expected. This may be due to the area being prepared for IORT by placing tissue compactly.
authors.affiliation: Department of Radiotherapy, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliera Universitaria, Istituto Nazionale per la Ricerca sul Cancro, San Martino, Genoa, Italy. marina.guenzi@istge.it
authors.forename: Marina
authors.initials: M
authors.lastname: Guenzi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fozza
authors.forename: Gladys
authors.initials: G
authors.lastname: Blandino
authors.forename: Giorgia
authors.initials: G
authors.lastname: Timon
authors.forename: Liliana
authors.initials: L
authors.lastname: Belgioia
authors.forename: Giulia
authors.initials: G
authors.lastname: Vidano
authors.forename: Francesca
authors.initials: F
authors.lastname: Cavagnetto
authors.forename: Marco
authors.initials: M
authors.lastname: Gusinu
authors.forename: Stefano
authors.initials: S
authors.lastname: Agostinelli
authors.forename: Stefania
authors.initials: S
authors.lastname: Garelli
authors.forename: Michele
authors.initials: M
authors.lastname: Zeverino
authors.forename: Gianni
authors.initials: G
authors.lastname: Taccini
authors.forename: Renzo
authors.initials: R
authors.lastname: Corvò
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D015412:Mastectomy, Segmental; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed