radiation therapy planning techniques in reducing damage to normal tissue in women undergoing breast-conserving surgery for ductal carcinoma of the breast

Conditions: Breast Cancer

Summary: rationale: diagnostic procedures, such as multifunctional magnetic resonance imaging and ct scans, may help reduce normal tissue damage in patients undergoing radiation therapy for cancer. purpose: this clinical trial is studying how well radiation therapy planning techniques work in reducing damage to normal tissue in women undergoing breast-conserving surgery for ductal breast carcinoma.

objectives: * to improve precision of tumor bed localization and definition of clinical target volume, and to reduce normal tissue irradiation in women undergoing partial breast or breast boost radiotherapy. * to test whether post-operative mri improves the precision of tumor bed delineation after wide-local excision in comparison with the current standard ct scan/clip method. * to determine the impact of tumor position within the excision specimen upon the localization of clinical target volume in relation to the tumor bed. * to compare theoretical non-target tissue exposure from partial breast irradiation planned in the supine and prone (face-down) positions. outline: patients undergo planned breast-conservation surgery and placement of titanium clips to the four radial, the deep, and superficial margins of the excision cavity (for localization of tumor bed). within 2 weeks after surgery, patients undergo supine radiotherapy-planning ct scan as standard analysis. patients then undergo a radiotherapy-planning ct scan in the prone position. patients complete a linear analogue questionnaire after both scans designed to assess patient comfort and anxiety in each position. patients then undergo multifunctional mri (including dynamic contrast-enhancement mri and diffusion-weighted mri) of the ipsilateral breast in the prone position (≥ 3 weeks after surgery). if suspicious lesions ≥ 5 mm are found on mri, patients are referred for a second-look ultrasound with biopsy (if lesion visible on ultrasound); where suspicious lesions are seen only on mri, patients undergo mri-guided biopsy. lesions \< 5 mm are included in the whole-breast radiotherapy treatment.

Eligibility criteria:
disease characteristics: * planning to undergo breast-conserving surgery (bcs)\* for unifocal ductal carcinoma in situ (dcis) or grade 1-2 invasive ductal carcinoma (idc) of the breast note: \*patients who have underwent bcs and have titanium clips placed according to this protocol are eligible for this study. * no t4d or multifocal disease (as defined on mammography or ultrasound) * no g3 disease * hormone receptor status not specified patient characteristics: inclusion criteria: * female * menopausal status not specified exclusion criteria: * cup size dd or greater * ferromagnetic implants (exclude participation in mri) * claustrophobia (exclude participation in mri) * gadolinium allergy prior concurrent therapy: * no prior surgery to ipsilateral breast * no prior neoadjuvant chemotherapy

Keywords: ductal breast carcinoma in situ invasive ductal breast carcinoma breast cancer in situ stage i breast cancer stage ii breast cancer stage iiia breast cancer