Cancer Res Treat.  2006 Feb;38(1):40-47.

The Effect of Simulation on Recurrence after Breast-Conserving Surgery and Radiotherapy : Preliminary Results

• Kim JY
• Kim YS
• Ryu MR
• Kim SW
• Kay CS
• Yoon SC
• Park WC
• Song BJ
• Oh SJ
• Jung SS
• Won JM
• Kim SN
• Chung SM

Abstract

PURPOSE
To evaluate the effect of the simulation method on recurrence among the patients who received radiotherapy after breast-conserving surgery (BCS) for early breast carcinoma.
METHODS
AND MATERIALS: Between 1995 and 2000, 70 patients with stage I-II breast carcinoma underwent breast-conserving surgery and adjuvant radiotherapy. Twenty nine patients (41.4%) were simulated with the 2D contour-based method (September 1995 to August 1997) and 41 patients (58.6%) were simulated with the 3D CT-based method (September 1997 to February 2000). To analyze the effect of the simulation method, the patient and treatment characteristics were compared.
RESULTS
The characteristics were similar for the patients between the 2D contour-based simulation group and the 3D CT-based simulation group. During a median follow-up period of 75 months, 4 (13.8%) of 29 patients who were treated with 2D simulation and 1 (2.4%) of 41 patients who were treated with 3D simulation group devel-oped treatment failure. The five-year survival rates were 89.2% and 95.1% between the 2D and 3D simulation groups (p=0.196). The five-year disease free survival (DFS) rates were 86.2% and 97.5% between the 2D and 3D simulation groups (p=0.0636). On univariate analysis, age > 40 (p= 0.0226) and the number of dissected axillary lymph node > or = 10 (p=0.0435) were independent predictors of improved 5-year DFS.
CONCLUSIONS
Although our data showed marginal significance for the DFS between the two groups, it is insufficient, due to the small number of patients in our study, to prove whether 3D CT-based simulation might improve the DFS and reduce the risk of recurrence when compared with 2D contour-based simulation. Further study is needed with a larger group of patients.

Keyword

Breast neoplasms; Radiotherapy; Simulation; Recurrence

MeSH Terms

Breast Neoplasms
Disease-Free Survival
Follow-Up Studies
Humans
Lymph Nodes
Mastectomy, Segmental*
Radiotherapy*
Radiotherapy, Adjuvant
Recurrence*
Survival Rate
Treatment Failure

Figure

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  Fig. 1 2D Contour-based simulation. (A) The 2D simulation film; radiopaque wires are noted at breast and axillary scar. Catheters indicating medial and lateral margin coincide at the center. (B) Contouring using plaster mold.

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  Fig. 2 3D CT-based simulation. (A) CT simulator, (B) 3D CT-based simulation film (beam's eye view on a reconstructed CT image), (C) 3D dose distribution at the isocenter.

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  Fig. 3 Overall survival in all patients. The 5-year overall survival rate was 91.4%.

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  Fig. 4 Disease-free survival in all patients. The 5-year disease-free survival rate was 92.7%.

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  Fig. 5 Comparison of the 5-year overall survival (A, 89.2% vs 95.1%, respectively, p=0.196) and 5-year disease-free survival (B, 86.2% vs 97.5%, respectively, p=0.0636) between 2D and 3D simulation groups.

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