Article Introduction Several previous prospective randomized trials and their meta-analysis proved that in the treatment of breast tumours, radiation therapy is an important part of breast conserving therapy.
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Breast conserving surgery and the subsequent irradiation of the remaining breast tissue ensure the same survival rate as radical breast surgery. In our previous paper the dosimetrical differences of the external beam and interstitial brachytherapy for APBI were evaluated.
In a phase II sequential trial was launched at our institution. Patients and methods Patients For this study 40 patients were selected, who were previously treated with early-stage invasive breast cancer at our institution between and in a phase II APBI trial.
The trial was registered at ClinicalTrials. During breast-conserving surgery titanium surgical clips were placed in each patient to mark the boundaries of the excision cavity, which increased the accuracy of defining the resection cavity and consequently the planning target volume PTV.
Around both breasts and on the surgical scar metal wires were placed to increase the precision of contouring.
CT scans started from the mandible and included the complete volume of the lungs and the volumes of both breasts. The most crucial part of partial breast irradiation is the exact localization of the excision cavity.
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Using titanium clips and the 3 mm thickness of the planning CT slices, the borders of surgical cavity could be defined in accepTable precision. In the first step of target volume definition, the tumour bed was contoured by the radiation oncologist based on the seroma and the surrounding clips.
In the second step, on the basis of prostate volume normal range in cc intact surgical margins and pathological results, it was expanded in 6 directions with margins of different size to define CTV. The minimal and maximal value of the extension between the tumour bed and the CTV was 5 and 18 mm, respectively. As the skin is an organ at risk during partial breast irradiation, a 5 mm thick volume of the skin was cropped from PTV to create PTVeval. Heart, ipsilateral and contralateral breasts and lungs, non-target breast were contoured as organs at risk.
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Non-target breast was created with the extraction of PTV from ipsilateral breast. Planning purposes To make the techniques comparable, the same target coverage was achieved for all plans. These requirements were fulfilled in all of the plans.
Planning The 3D-CRT plans were created with 4 or 5 wedged conformal non-coplanar fields from tangential directions Figure 1. Avoidance sectors were not applied, only strict constrains A prosztata népi receptek gyulladása given for ipsilateral lung, heart and spine.
All plans were created for linear accelerator equipped with 5 mm wide MLC and 6 MV photon energy was used.