이화의대 / 정원근, 김규보*
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 ΔX (lateral-medial), ΔY (anterior-posterior), ΔZ (superior-inferior), and three-dimensional (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.
그림 설명: 수술용 클립의 변위-A,B: ADM이 있는 환자, C,D: ADM이 없는 환자
Author information
Jung W1, Kim K1, Paik NS2.
1
Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea.
2
Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea.
편집위원
본 연구는 여상 암환자의 다수를 차지하는 유방암 환자에 대한 수술시 ADM을 사용한 경우와아닌 경우에 대하여 추후 방사선치료의 가이드 역할을 위해 삽입하는 클립의 체내 이동에 대한 연구로서 부분유방 절제술 시행 후 조직 복원을 위한 의료용 인체 삽입용 보형물의 영향에 대한 연구로서 흥미롭습니다.
2020-05-28 14:07:28