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Partial Breast Irradiation using Multicatheter Brachytherapy
Vratislav Strnad, Oliver J. Ott (eds.)
Verlag W. Zuckschwerdt Verlag, 2006
ISBN 9783886039012 , 165 Seiten
Format PDF, OL
Kopierschutz DRM
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Contents
6
Target volume definition after closed-cavity surgery: clinical considerations
42
Contributors
8
Introduction
10
Patterns of care for breast brachytherapy in Europe
12
Introduction
12
The main tumour sites treated with brachytherapy
12
Breast cancer in Europe
13
Partial breast irradiation with multi- catheter brachytherapy: how hazardous is it?
16
The basic importance of whole breast irradiation ( WBI)
16
How patient selection impacts local control after breast- conserving surgery and whole breast irradiation
17
Local recurrence after accelerated partial breast irradiation ( APBI) with strict patient selection
19
Local recurrence after APBI without strict patient selection
20
Summary
22
Patient selection criteria and pathological considerations
24
Introduction
24
Evidence-based selection criteria for APBI
24
Treatment-related prognostic factors Surgical margins and radiation dose
26
Patient-related and tumour-related predictive factors Patient age
28
Patient age
28
Extensive intraductal component
28
Tumour size
29
Histological grade
29
Invasive lobular carcinoma
30
Ductal carcinoma in situ
30
Hormone receptor status
31
Lymphatic Spread
31
Conclusions
32
Pre-brachytherapy imaging procedures
38
Introduction
38
Clinical assessment
38
Technical methods
38
Summary
41
Target volume definition after closed-cavity surgery: clinical considerations
42
Introduction
42
Individual variations of the anatomy of the female breast after breastconserving surgery
42
Value of the surgical report and the pathological report
44
Value of the skin scar
46
Value of sonography
47
Value of mammography, CT, and MRI
48
Value of surgical clips
51
Summary
52
Target volume definition after open-cavity surgery: clinical considerations
56
Basic clinical considerations for target definition in breast radiotherapy
56
What should be the target volume for partial breast brachytherapy?
56
Anaesthesia and patient care
62
Introduction
62
Anaesthesia
62
Positioning of the patient
63
Instruments
63
Surgical report
63
Postoperative monitoring after general anaesthesia
63
Care of the tubes
64
Removal of the tubes
65
Care instruction after multi-catheter brachytherapy of the breast
66
Clip-based implant technique using an Integrated Brachytherapy Unit (IBU)
68
CT-based implant technique after closed-cavity surgery
72
Introduction
72
Pre-implantation CT-based simulation of the tumour bed
73
Implantation procedure
73
Post-implantation CT and reconstruction of implant geometry
74
Target volume definition (CTV/PTV) and delineation of organs at risk (OARs)
74
CT-based calculation and optimization of 3D-physical dose distribution
74
CT-based implant technique after open-cavity surgery: European policy
80
CT-based implant technique after open-cavity surgery: American policy
86
Introduction
86
Catheter placement technique
86
Dose delivery parameters
89
Ultrasound-based implant technique
92
Introduction
92
Ultrasound-guided multi-catheter implantation
94
Conclusion
98
Physical aspects: dosimetry, planning, and documentation
100
Introduction
100
Dose calculation formalism
100
Treatment planning
101
Biological aspects: total dose and fractionation
116
Introduction
116
The linear quadratic model
117
The LQ model in brachytherapy
119
Pulsed-dose-rate (PDR) brachytherapy
120
Conclusions
120
Normal-tissue constraints
124
Introduction
124
Breast fibrosis
124
Skin teleangiectasia
125
Fat necrosis
128
Summary
130
Clinical results: European experience
134
Introduction
134
Guy’s Hospital studies
134
Uzsoki Hospital’s cobalt-needle study
136
Florence series
136
Royal Devon/Exeter Hospital series
137
Ninewells Hospital’s study
137
Örebro series
137
National Institute of Oncology (Hungary) phase II study
137
German-Austrian multicentric trial
138
National Institute of Oncology (Hungary) phase III trial
139
Summary of European experience
140
Clinical results: American experience
142
Introduction
142
William Beaumont Hospital
142
Ochsner Clinic
144
Tufts-Brown Universities
144
Radiation Therapy Oncology Group 95-17
145
Conclusions
145
Current randomised trials
148
Introduction
148
The European GEC-ESTRO APBI Trial
148
The North-American NSABP B-39/RTOG 0413 Trial
150
Comparison of the European GECESTRO APBI Trial and the North- American NSABP B-39/RTOG 0413 Trial
153
Summary
155
Summary
158
Index
160
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