Clinical Factors Associated With Seroma Volume Reduction in Breast-Conserving Therapy for Early-Stage Breast Cancer: A Multi-Institutional Analysis

Yang, Tzu-I J.; Elkhuizen, Paula H.M.; Minkema, Danny; Heemsbergen, Wilma; van Mourik, Anke M.; Cassee, Jorien; Hurkmans, Coen; van Vliet-Vroegindeweij, Corine

doi:10.1016/j.ijrobp.2009.03.056

« Previous Next »International Journal of Radiation Oncology * Biology * Physics
Volume 76, Issue 5 , Pages 1325-1332, April 2010

Clinical Factors Associated With Seroma Volume Reduction in Breast-Conserving Therapy for Early-Stage Breast Cancer: A Multi-Institutional Analysis

Tzu-I J. Yang, B.S.R.T.(T).
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Yale University School of Medicine, New Haven, CT
Paula H.M. Elkhuizen, M.D., Ph.D.
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Danny Minkema, R.T.(T).
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Wilma Heemsbergen, Ph.D.
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Anke M. van Mourik, Ph.D.
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Jorien Cassee, R.T.(T).
- Department of Radiation Therapy, Catharina Hospital, Eindhoven, The Netherlands
Coen Hurkmans, Ph.D.
- Department of Radiation Therapy, Catharina Hospital, Eindhoven, The Netherlands
Corine van Vliet-Vroegindeweij, Ph.D.
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Reprint requests to: Corine van Vliet-Vroegindeweij, Ph.D., Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Tel: (+31) (0) 205122243; Fax: (+31) (0) 206691101

Received 6 February 2009; received in revised form 16 March 2009; accepted 31 March 2009. published online 06 October 2009.

Purpose

To correlate clinical factors with seroma volume and reduction; and to determine whether cone-beam CT (CBCT) could be used clinically to monitor seroma reduction.

Patients and Methods

This investigation included 102 women from five institutions with stage T1–2 breast cancer treated with breast-conserving therapy. Two CT scans were acquired: the planning CT (CT1) and a second CT (CT2) during radiotherapy (RT). Seroma was contoured on all scans, and correlations between seroma characteristics and clinical factors were investigated by univariate and multivariate analyses. In a substudy, 10 of the 102 patients received multiple CBCT scans during RT. Seroma were contoured by two observers in the substudy. Fifteen time points at which CT and CBCT were performed within 2 days were identified. The levels of correlation in seroma contours between CBCT and CT and between the two observers were examined.

Results

The mean relative seroma reduction from CT1 to CT2 was 54% (p < 0.001). A significant inverse relationship was found between relative seroma reduction per week and number of RT fractions given by univariate and multivariate analyses (p = 0.01, 0.03). The mean difference in contoured seroma volumes between CT and CBCT was 12% (3.3 cm³). When assessing the relative difference in seroma contours between Observer 1 and Observer 2, an interobserver difference of 12% was demonstrated. Neither discrepancy was clinically significant.

Conclusions

Radiotherapy seems to hinder seroma reduction. Volume discrepancies between CBCT and CT were minor, with low interobserver variation, indicating that CBCT might be useful in monitoring seroma reduction.

Radiotherapy, Breast-conserving therapy, Postoperative seroma, Boost volume, Cone-beam CT