The influence of the use of CT-planning on the irradiated boost volume in breast conserving treatment.

Abstract

The purpose of this study was to investigate the effect of CT-based delineation and planning on the irradiated boost volume. For this specific purpose we used the data as derived from 2 prospective phase III randomised trials. Data from 1331 patients (<or=50 years) were analyzed with a reported boost volume from a simulation-based treatment plan (EORTC boost vs no boost trial, n=922), and a CT-scan-based treatment plan (Young Boost Trial, n=409) group. Tumour diameter, irradiation technique (photons vs electrons), lumpectomy size, and age were used as covariates. Median V(95%) in the conventional simulation-based treatment plans was 99 cc (range 9-628) for photons and was 98 cc (13-651) for electrons, whereas in the CT-planned patients, these figures were 178 cc (37-2699) and 150 cc (43-1272), respectively. Multivariable analysis showed an association of the irradiated boost volume with tumour size (p<0.0067), lumpectomy size (p<0.0002), and boost technique (p<0.0004). The use of a CT-scan for volume delineation and treatment planning remained significant (p<0.0001). The use of a CT-scan for delineation and treatment planning led to a significant increase of the irradiated boost volume by a factor of 1.5-1.8, compared to conventional simulator-based plans.