Marking of tumor resection borders for improved radiation planning facilitates reduction of radiation dose to free flap reconstruction in head and neck cancer surgery.

Bittermann, Gido; Wiedenmann, Nicole; Voss, Pit; Zimmerer, Ruediger; Duttenhoefer, Fabian; Metzger, Marc C

Bittermann, Gido; Wiedenmann, Nicole; Voss, Pit; Zimmerer, Ruediger; Duttenhoefer, Fabian; Metzger, Marc C.

Afiliación

Bittermann G; Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 3, D-79106 Freiburg, Germany. Electronic address: gido.bittermann@uniklinik-freibu
Wiedenmann N; Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 3, D-79106 Freiburg, Germany.
Voss P; Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 3, D-79106 Freiburg, Germany.
Zimmerer R; Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 3, D-79106 Freiburg, Germany.
Duttenhoefer F; Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 3, D-79106 Freiburg, Germany.
Metzger MC; Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 3, D-79106 Freiburg, Germany.

J Craniomaxillofac Surg ; 43(4): 567-73, 2015 May.

Article en En | MEDLINE | ID: mdl-25841307

RESUMEN

Accurate localization of tumor resection borders is crucial for adjuvant radiotherapy. An improvement to adjuvant radiotherapy with the reduction of radiation doses to free flap reconstruction by virtual navigation procedures and titanium clips was evaluated. Thirty-three patients with oral cancer were prospectively included in the study. Following complete local excision of the primary tumor, resection borders were marked virtually using a navigation pointer and with titanium ligature clips. Postoperative delineation of tumor resection borders was examined. In five patients with microvascular free flap reconstruction a reduction of the radiation dose to the free flap reconstruction was achieved. The tumor resection borders in 30 patients were marked with titanium ligature clips. Surgical clip insertion was successful in 91%. We demonstrate a significant relationship between the reconstruction volume and the part of the target volume which will receive a reduced radiation dose. A cumulative dose of 60 Gy was administered to the target volume and a significant reduction of the administered radiation dose to the center of the flap could be demonstrated. We demonstrate an accurate delineation of the tumor resection margins. These improvements in tumor resection margin delineation allow for increased accuracy in adjuvant treatment and a reduction of radiation dose to the vascular free flap reconstruction.

Asunto(s)

Carcinoma de Células Escamosas/cirugía; Colgajos Tisulares Libres/trasplante; Neoplasias de la Boca/cirugía; Planificación de Atención al Paciente; Procedimientos de Cirugía Plástica/métodos; Dosificación Radioterapéutica; Radioterapia Adyuvante/métodos; Adulto; Anciano; Anciano de 80 o más Años; Carcinoma de Células Escamosas/radioterapia; Quimioradioterapia Adyuvante/métodos; Estudios de Factibilidad; Femenino; Humanos; Ligadura/instrumentación; Masculino; Microcirugia/instrumentación; Microcirugia/métodos; Persona de Mediana Edad; Neoplasias de la Boca/radioterapia; Disección del Cuello/métodos; Proyectos Piloto; Estudios Prospectivos; Radioterapia Guiada por Imagen/métodos; Radioterapia de Intensidad Modulada/métodos; Cirugía Asistida por Computador/métodos; Instrumentos Quirúrgicos; Titanio/química; Tomografía Computarizada por Rayos X/métodos; Interfaz Usuario-Computador

Palabras clave

Adjuvant radiotherapy; Clips; Computer assisted surgery; Head and neck cancer; Tumor resection margin delineation

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Planificación de Atención al Paciente / Dosificación Radioterapéutica / Neoplasias de la Boca / Carcinoma de Células Escamosas / Radioterapia Adyuvante / Procedimientos de Cirugía Plástica / Colgajos Tisulares Libres Tipo de estudio: Observational_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Craniomaxillofac Surg Asunto de la revista: ODONTOLOGIA Año: 2015 Tipo del documento: Article Pais de publicación: Reino Unido

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