Dosimetric Comparison and Evaluation of Three Radiotherapy Techniques for Use after Modified Radical Mastectomy for Locally Advanced Left-sided Breast Cancer.
Dosimetric Comparison and Evaluation of Three Radiotherapy Techniques for Use after Modified Radical Mastectomy for Locally Advanced Left-sided Breast Cancer.
复制标题
局部晚期左侧乳腺癌改良根治术后使用的三种放射治疗技术的剂量学比较和评估
DOI：
10.1038/srep12274
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发表时间：
2015-07-21
影响因子：
4.6
通讯作者：
Li D
中科院分区：
文献类型：
--
作者：
Ma C;Zhang W;Lu J;Wu L;Wu F;Huang B;Lin Y;Li D
本研究旨在比较改良后乳房根治放疗（PMRMRT）治疗左侧乳腺癌的三维适形放射治疗与场内放射技术（3DCRT-FinF）、5场调强放射治疗（5F-IMRT）和2部分弧体积调制弧治疗（2P-VMAT）。我们为10个连续的病人分别制定了3个不同的PMRMRT计划。我们进行了Kruskal-Wallis方差分析（ANOVA），然后进行了Dunn型多重比较，以建立计划质量和剂量学效益的层次结构。P < 0.05为差异有统计学意义。5F-IMRT和2P-VMAT方案的PTV覆盖率（V95%）、热点区域（V110%）和符合性（p < 0.05）相似，且PTV覆盖率显著高于3DCRT-FinF方案（p < 0.001）。此外，5F-IMRT计划提供的心脏和左肺辐射暴露明显少于2P-VMAT（均p < 0.05）。与低估CTV位移的计划相比，精确估计CTV位移的3DCRT-FinF计划显示出更高的靶覆盖范围，但更差的危险器官（OARs）保留。我们的研究结果表明，与其他两种PMRMRT技术相比，5F-IMRT具有剂量优势，因为它在PTV覆盖和OAR保留（特别是心脏保留）之间取得了最佳平衡。单独量化和最小化CTV位移可以显著改善剂量分布。
This study aimed to compare the post-modified radical mastectomy radiotherapy (PMRMRT) for left-sided breast cancer utilizing 3-dimensional conformal radiotherapy with field-in-field technique (3DCRT-FinF), 5-field intensity-modulated radiation therapy (5F-IMRT) and 2- partial arc volumetric modulated arc therapy (2P-VMAT). We created the 3 different PMRMRT plans for each of the ten consecutive patients. We performed Kruskal-Wallis analysis of variance (ANOVA) followed by the Dunn’s-type multiple comparisons to establish a hierarchy in terms of plan quality and dosimetric benefits. P < 0.05 was considered statistically significant. Both 5F-IMRT and 2P-VMAT plans exhibited similar PTV coverage (V95%), hotspot areas (V110%) and conformity (all p > 0.05) and significantly higher PTV coverage compared with 3DCRT-FinF (both p < 0.001). In addition, 5F-IMRT plans provided significantly less heart and left lung radiation exposure than 2P-VMAT (all p < 0.05). The 3DCRT-FinF plans with accurately estimated CTV displacement exhibited enhanced target coverage but worse organs at risk (OARs) sparing compared with those plans with underestimated displacements. Our results indicate that 5F-IMRT has dosimetrical advantages compared with the other two techniques in PMRMRT for left-sided breast cancer given its optimal balance between PTV coverage and OAR sparing (especially heart sparing). Individually quantifying and minimizing CTV displacement can significantly improve dosage distribution.