Traitement conservateur du cancer du sein : optimisation du repérage du lit tumoral

Contouring workload in adjuvant breast cancer radiotherapy

PURPOSE

To measure the impact of contouring on worktime in the adjuvant radiation treatment of breast cancer, and to identify factors that might affect the measurements.

MATERIAL AND METHODS

The dates and times of contouring clinical target volumes and organs at risk were recorded by a senior and by two junior radiation oncologists. Outcome measurements were contour times and the time from start to approval. The factors evaluated were patient age, type of surgery, radiation targets and setup, operator, planning station, part of the day and day of the week on which the contouring started. The Welch test was used to comparatively assess the measurements.

RESULTS

Two hundred and three cases were included in the analysis. The mean contour time per patient was 34minutes for a mean of 4.72 structures, with a mean of 7.1minutes per structure. The clinical target volume and organs at risk times did not differ significantly. The mean time from start to approval per patient was 29.4hours. Factors significantly associated with longer contour times were breast-conserving surgery (P=0.026), prone setup (P=0.002), junior operator (P<0.0001), Pinnacle planning station (P=0.026), contouring start in the morning (P=0.001), and contouring start by the end of the week (P<0.0001). Factors significantly associated with time from start to approval were age (P=0.038), junior operator (P<0.0001), planning station (P=0.016), and contouring start by the end of the week (P=0.004).

CONCLUSION

Contouring is a time-consuming process. Each delineated structure influences worktime, and many factors may be targeted for optimization of the workflow. These preliminary data will serve as basis for future prospective studies to determine how to establish a cost-effective solution.

Oncoplastic reconstruction with superior based lateral breast rotation flap after lower quadrant tumor resection

Purpose

Poor cosmetic outcome have been reported as a result of breast cancer operation due to lower quadrant breast tumors; this is particularly true for women with small, firm breasts. Herein, we report here on the use of superior based lateral breast rotation flap reconstruction to improve cosmetic outcome in patients with lower quadrant breast cancer.

Methods

We enrolled 33 patients with invasive breast cancer located in the lower quadrant of the breast, which were located more than 2 cm apart from the nipple. After completing a quadrantectomy, a single S-shaped or reverse S-shaped incision was made from axilla to tumor site. Two triangular skin islands, one on the axilla and one overlying the tumor were marked for excision. Once the fibroglandular tissues and the additional fatty tissue of the lateral chest wall were appropriately mobilized, the breast defect was closed at the mid-point of the parenchymal thickness in order to keep the natural position of the infra mammary fold.

Results

Median tumor size was 2.3 cm (range, 0.7-3.5 cm) and median resected volume was 35.5 g (range, 27.0-51.0 g). With a mean follow-up of 24.5 months (range, 9.0-33.5 months), cosmetic outcomes were good (94.0%) to fair (6.0%) at 6 months after the procedure, and there was no local or systemic recurrence during the short term follow-up period.

Conclusion

Clearly, this type of rotation flap reconstruction is an oncologically safe and a cosmetically sound procedure. Hopefully this rotation flap reconstruction technique will become more widely available and perhaps a standard procedure for lower quadrant breast tumors, especially for cosmetic treatment of small to medium-sized breasts.