title: To clip or not to clip the breast tumor bed? A retrospective look at the geographic miss index and normal tissue index of 110 patients with breast cancer.
abstract: Planning of breast radiation for patients with breast conserving surgery often relies on clinical markers such as scars. Lately, surgical clips have been used to identify the tumor location. The purpose of this study was to evaluate the geographic miss index (GMI) and the normal tissue index (NTI) for the electron boost in breast cancer treatment plans with and without surgical clips.
  
  
  
  A retrospective descriptive study of 110 consecutive post-surgical patients who underwent breast-conserving treatment in early breast cancer, in which the clinical treatment field with the radiologic (clipped) field were compared and GMI/NTI for the electron boost were calculated respectively.
  
  
  
  The average clinical field was 100 mm (range, 100-120 mm) and the clipped field was 90 mm (range, 80-100 mm). The average GMI was 11.3% (range, 0-44%), and the average NTI was 27.5% (range, 0-54%). The GMI and NTI were reduced through the use of intra-surgically placed clips.
  
  
  
  The impact of local tumor control on the survival of patients with breast cancer is also influenced by the precision of radiotherapy. Additionally, patients demand an appealing cosmetic result. This makes "clinical" markers such as scars unreliable for radiotherapy planning. A simple way of identifying the tissue at risk is by intra-surgical clipping of the tumor bed. Our results show that the use of surgical clips can reduce the diameter of the radiotherapy field and increase the accuracy of radiotherapy planning. With the placement of surgical clips, more tissue at risk is included in the radiotherapy field. Less normal tissue receives radiotherapy with the use of surgical clips.
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ebner
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: de Gregorio
authors.affiliation: Department of Obstetrics and Gynecology, Diakonie-Klinikum Schwäbisch Hall, Women's Clinic with Breast Center and Genital Cancer Center, Schwäbisch Hall, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rempen
authors.affiliation: Department of Radiotherapy, Diakonie-Klinikum Schwäbisch Hall, Schwäbisch Hall, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Mohr
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany.
authors.forename: Amelie
authors.initials: A
authors.lastname: de Gregorio
authors.affiliation: University of Würzburg Head of Department Prof. A. Wöckel Women's Clinic and Polyclinic, Würzburg, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Wöckel
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Janni
authors.affiliation: Department of Radiotherapy, Diakonie-Klinikum Schwäbisch Hall, Schwäbisch Hall, Germany.
authors.forename: Gerlo
authors.initials: G
authors.lastname: Witucki
keywords: Breast cancer; boost reduction.; clips; geographic miss index; normal tissue index; radiotherapy