Jee Suk Chang1, Hwa Kyung Byun1, Jun Won Kim2, Kyung Hwan Kim3, Jeongshim Lee1, Yeona Cho1, Ik Jae Lee2, Ki Chang Keum1, Chang-Ok Suh1, Yong Bae Kim4. 1. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea. 2. Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. 3. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea. 4. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: ybkim3@yuhs.ac.
Abstract
BACKGROUND AND PURPOSE: To explore the validity of the ESTRO-clinical target volume (CTV), we conducted three-dimensional analyses of locoregional recurrence (LRR) patterns according to the ESTRO- and RTOG-CTVs. Moreover, we explored which factors contribute to metastasis development outside the recommended CTV. MATERIALS AND METHODS: We identified patients with post-treatment LRR explicitly exhibited on computed tomography (CT) images. All recurrences on CT were overlaid on representative CT images at the equivalent location, based on reference anatomic structures. RESULTS: A total of 235 recurrent lesions were identified in 129 patients. We depicted all LRR patterns in relation to the ESTRO- and RTOG-CTVs on CT and maximum intensity projection images. The ESTRO-CTV successfully contained the extent of the LRR within the RTOG-CTV in 96.4% of all early-stage breast-conserved women. Geographic misses of local recurrence were frequently observed in mastectomy patients (P=.002) and tended to originate from deep, but thin, chest walls. The rate of geographic misses of regional recurrence was low (3.6%) at the early stage, but increased in patients aged <45years and with triple-negative tumors (P<.05). CONCLUSIONS: Application of the ESTRO-CTV in early-stage disease seems justified.
BACKGROUND AND PURPOSE: To explore the validity of the ESTRO-clinical target volume (CTV), we conducted three-dimensional analyses of locoregional recurrence (LRR) patterns according to the ESTRO- and RTOG-CTVs. Moreover, we explored which factors contribute to metastasis development outside the recommended CTV. MATERIALS AND METHODS: We identified patients with post-treatment LRR explicitly exhibited on computed tomography (CT) images. All recurrences on CT were overlaid on representative CT images at the equivalent location, based on reference anatomic structures. RESULTS: A total of 235 recurrent lesions were identified in 129 patients. We depicted all LRR patterns in relation to the ESTRO- and RTOG-CTVs on CT and maximum intensity projection images. The ESTRO-CTV successfully contained the extent of the LRR within the RTOG-CTV in 96.4% of all early-stage breast-conserved women. Geographic misses of local recurrence were frequently observed in mastectomy patients (P=.002) and tended to originate from deep, but thin, chest walls. The rate of geographic misses of regional recurrence was low (3.6%) at the early stage, but increased in patients aged <45years and with triple-negative tumors (P<.05). CONCLUSIONS: Application of the ESTRO-CTV in early-stage disease seems justified.
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