Frontiers in oncology · 2026
Influencing factors of significant breast edema in breast cancer patients undergoing breast-conserving surgery during radiotherapy with DIBH.
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Sang Yong, Su Xiaoye, Hu Nan, Wu Jianan, Huang Lijuan, Jin Jing, Xiao Qin
Аннотация
BACKGROUND AND PURPOSE: Breast-conserving surgery (BCS) followed by radiotherapy is the standard of care for most early-stage breast cancer. Although Breast edema (BE) following radiotherapy has been widely reported, current studies mainly focuses on factors influencing post-radiotherapy BE and its impact on quality of life. This study investigates the factors associated with significant Breast edema (SBE) during radiotherapy, which may lead to notable changes in target dose distribution and potentially necessitate replanning, aiming to provide guidance for clinical management.
METHODS: We retrospectively analyzed 144 patients who received radiotherapy after BCS at our institution from May 2024 to November 2025. All patients underwent deep inspiration breath-hold (DIBH) during simulation CT, cone beam computed tomography (CBCT) imaging, and treatment delivery. SBE during radiotherapy was defined as a breast dimensional increase of ≥5 mm in either the X or Z direction on at least one of three CBCT scans (obtained before the 1st, 6th, and 11th fractions), based on the institutional margin of 5 mm from clinical target volume (CTV) to planning target volume (PTV). Potential influencing factors included height, weight, body mass index (BMI), tumor location, age, TNM stage, chemotherapy, radiation energy, volumes of CTV, CTVboost, PTV, and PTVboost, as well as dosimetric parameters for PTVboost and PTV-PTVboost.
RESULTS: Univariate analysis showed that the volume of CTV, CTVboost, PTV and PTVboost were significant predictors of SBE during radiotherapy With odds ratios (OR) slightly above 1.000 indicating a positive association. Multivariate analysis identified PTVboost volume was the only independent factor significantly associated with increased risk of SBE (OR = 1.072, 95% CI: 1.010-1.137, p = 0.022). Receiver operating characteristic (ROC) curve analysis determined the optimal cutoff value of PTVboost volume for predicting SBE to be 107.5 cc, yielding a sensitivity of 0.800 and a specificity of 0.560.
CONCLUSIONS: PTVboost volume was the only significant factor influencing the occurrence of SBE during radiotherapy. A larger PTVboost volume was associated with a higher probability of SBE, possibly related to surgical extent and volume receiving high-dose irradiation. Increased attention should be paid to SBE in BCS patients during radiotherapy due to its implications for treatment accuracy and patient quality of life. Proactive management of SBE is recommended in this setting.
METHODS: We retrospectively analyzed 144 patients who received radiotherapy after BCS at our institution from May 2024 to November 2025. All patients underwent deep inspiration breath-hold (DIBH) during simulation CT, cone beam computed tomography (CBCT) imaging, and treatment delivery. SBE during radiotherapy was defined as a breast dimensional increase of ≥5 mm in either the X or Z direction on at least one of three CBCT scans (obtained before the 1st, 6th, and 11th fractions), based on the institutional margin of 5 mm from clinical target volume (CTV) to planning target volume (PTV). Potential influencing factors included height, weight, body mass index (BMI), tumor location, age, TNM stage, chemotherapy, radiation energy, volumes of CTV, CTVboost, PTV, and PTVboost, as well as dosimetric parameters for PTVboost and PTV-PTVboost.
RESULTS: Univariate analysis showed that the volume of CTV, CTVboost, PTV and PTVboost were significant predictors of SBE during radiotherapy With odds ratios (OR) slightly above 1.000 indicating a positive association. Multivariate analysis identified PTVboost volume was the only independent factor significantly associated with increased risk of SBE (OR = 1.072, 95% CI: 1.010-1.137, p = 0.022). Receiver operating characteristic (ROC) curve analysis determined the optimal cutoff value of PTVboost volume for predicting SBE to be 107.5 cc, yielding a sensitivity of 0.800 and a specificity of 0.560.
CONCLUSIONS: PTVboost volume was the only significant factor influencing the occurrence of SBE during radiotherapy. A larger PTVboost volume was associated with a higher probability of SBE, possibly related to surgical extent and volume receiving high-dose irradiation. Increased attention should be paid to SBE in BCS patients during radiotherapy due to its implications for treatment accuracy and patient quality of life. Proactive management of SBE is recommended in this setting.