Cancer Res Treat.  2020 Apr;52(2):388-395. 10.4143/crt.2019.213.

Displacement of Surgical Clips in Patients with Human AcellularDermal Matrix in the Excision Cavity during Whole Breast IrradiationFollowing Breast-Conserving Surgery

• Jung W
• Kim K
• Paik NS

• KMID: 2500324
• DOI: http://doi.org/10.4143/crt.2019.213

Abstract

Purpose
The purpose of this study was to investigate the displacement of surgical clips in the excision cavity during whole breast irradiation following breast-conserving surgery (BCS) with or without acellular dermal matrix (ADM) insertion, and to analyze clinicopathologic factors associated with the displacement of surgical clips.
Materials and Methods
From 2016 to 2017, 100 consecutive breast cancer patients who underwent BCS with the placement of surgical clips (superior, inferior, medial, lateral, and deep sides) in the tumor bed were included in this study. All patients took first planning computed tomography (CT) scan (CT 1) before whole breast irradiation and second CT scan (CT 2) before boost irradiation. Between two sets of planning CT, the displacement of surgical clips was calculated from the !X (lateral–medial), !Y (anterior–posterior), !Z (superior–inferior), and threedimensional (3D) directions. Patients were divided into two groups according to the breast volume replacement with ADM: group A with ADM and group B without ADM.
Results
The means and 1 standard deviations of 3D displacement for superior, inferior, medial, lateral and deep clips were 5.2±2.9, 5.2±3.2, 5.6±4.5, 5.6±4.3, and 4.9±4.9 mm in entire cohort (n=100); 5.6±2.6, 6.0±3.5, 6.7±5.8, 6.7±5.7, and 6.1±7.4 mm in group A (n=38); 4.9±3.1, 4.8±3.0, 5.0±3.5, 5.0±2.9, and 4.3±2.8 mm in group B (n=62), respectively. The 3D displacements of group A were longer than those of group B, but only significant difference was observed in lateral clip (p=0.047).
Conclusion
This study demonstrated displacement of surgical clips during whole breast irradiation in patients with ADM insertion. For patients who had breast volume replacement using ADM, adaptive boost planning should be considered.

Keyword

Breast-conserving surgery; Surgical clip; Displacement; Radiotherapy; Acellular dermal matrix

Figure

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  Fig. 1. Delineation of acellular dermal matrix (ADM) (yellow) on initial planning computed tomography (CT). (A) Native CT image. (B) Corresponding CT image with delineation of ADM.

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  Fig. 2. The displacement of surgical clips (superior clip-red, inferior clip-blue, medial clip-orange, lateral clip-yellow, and deep clip-green) in a right breast cancer patient before whole breast irradiation (A, C) and before boost irradiation (B, D). (A, B) In a patient with acellular dermal matrix (ADM) (margenta), the three-dimensional (3D) displacement for superior, inferior, medial, lateral, and deep clips were 11.4 mm, 16.2 mm, 5.1 mm, 9.6 mm, and 25.3 mm, respectively. (C, D) In a patient without ADM, the 3D displacement for superior, inferior, medial, lateral, and deep clips were 1.4 mm, 2.3 mm, 2.3 mm, 2.7 mm, and 1.4 mm, respectively.

Reference

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