title: Using injectable hydrogel markers to assess resimulation for boost target volume definition in a patient undergoing whole-breast radiotherapy.
abstract: Several publications have recommended that patients undergoing whole-breast radiotherapy be resimulated for boost planning. The rationale for this is that the seroma may be smaller when compared with the initial simulation. However, the decision remains whether to use the earlier or later images to define an appropriate boost target volume. A patient undergoing whole-breast radiotherapy had new, injectable, temporary hydrogel fiducial markers placed 1 to 3cm from the seroma at the time of initial simulation. The patient was resimulated 4.5 weeks later for conformal photon boost planning. Computed tomography (CT) scans acquired at the beginning and the end of whole-breast radiotherapy showed that shrinkage of the lumpectomy cavity was not matched by a corresponding reduction in the surrounding tissue volume, as demarcated by hydrogel markers. This observation called into question the usual interpretation of cavity shrinkage for boost target definition. For this patient, it was decided to define the boost target volume on the initial planning CT instead of the new CT.
authors.affiliation: Rutgers Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, Piscataway, NJ.
authors.forename: Henal
authors.initials: H
authors.lastname: Patel
authors.affiliation: Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, NJ.
authors.forename: Sharad
authors.initials: S
authors.lastname: Goyal
authors.affiliation: Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, NJ. Electronic address: kimlh@rutgers.edu.
authors.forename: Leonard
authors.initials: L
authors.lastname: Kim
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy*; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate
chemical_list: D020136:Hydrogel, Polyethylene Glycol Dimethacrylate
keywords: Boost target volume; Breast boost radiotherapy; Hydrogel fiducial markers; Resimulation