Installation of preoperative and intraoperative fiducial markers for radiation therapy in mammary gland surgery (literature review)

Over 5,000 new cases of breast cancer are diagnosed in the Republic of Kazakhstan every year. More than 40 % of them are treated with organ-preserving surgery followed by radiation therapy to minimize the risk of local recurrence. Notably, over 70 % of breast cancer recurrences occur within the primary tumor bed. Radiation therapy aims to prevent recurrence after radical surgery, and precise targeting is crucial for its effectiveness. However, the lack of standardized methods for the exact localization of the tumor margin presents a significant challenge. Radiation oncologists must carefully determine the tumor bed when planning radiation therapy.
Publications for analysis were searched in the PubMed and eLibrary databases using the relevant keywords.
Titanium surgical clips are commonly used to localize the tumor cavity in mammary gland radical surgery. However, tissue movement and postoperative seroma formation can compromise the positioning of clips within the cavity, especially with abnormal fluid accumulation. Originally designed for hemostasis, these clips may create ambiguity when used to mark tumor bed margins. Various alternative methods for more precise delineation of tumor bed margins have advantages and limitations regarding practicality, patient comfort, and precision. Despite certain challenges in clinical application, gold markers remain the most efficient way of localizing primary tumors and resection margins.
These findings highlight the urgent need for innovative approaches to marking the tumor cavity in mammary gland surgery to improve the precision of tissue localization for radiation therapy. Future advancements in this area should build on the advantages of gold markers and ensure accurate tumor localization.