Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer.
Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer.
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DOI：
10.1016/j.ijrobp.2010.04.072
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发表时间：
2010-12-01
影响因子：
7
通讯作者：
Pierce, Lori J.
中科院分区：
文献类型：
--
作者：
Jagsi, Reshma;Moran, Jean;Marsh, Robin;Masi, Kathryn;Griffith, Kent A.;Pierce, Lori J.
建立最佳调强放射治疗（IMRT）技术，用于治疗左乳腺和区域淋巴结，使用中度深吸气屏气。我们制定了四个不同的复杂性的调强放射治疗计划后，每10例患者左乳腺癌肿块切除术。对增强计划靶体积（PTV）规定了60戈伊的剂量，对乳房和锁骨上、锁骨下和内乳淋巴结规定了52.2戈伊的剂量。两种计划使用反向计划细光束技术：9场技术，具有9个等间距轴向光束，以及切向细光束技术，具有3到5个同侧光束。第三个计划（节段性技术）使用了前向计划多节段技术，第四个计划（节段性阻滞技术）相同，但包括一个阻滞以限制心脏剂量。生成剂量-体积直方图，并使用配对t检验分析选择用于比较的指标。平均心脏和左前降支冠状动脉剂量与切向细束和节段阻断技术相似，但节段和9射野技术较高（节段和切向细束技术之间的平均配对差异为15.1戈伊，p < 0.001）。大量对侧组织使用9射野技术接受剂量（平均右乳房V2，58.9%;平均右肺V2，75.3%）。对于切向细束技术，≥95%乳腺PTV的最小剂量平均为45.9戈伊，对于节段性阻断技术，最小剂量为45.0戈伊，对于节段性阻断技术，最小剂量为51.4戈伊，对于9射野技术，最小剂量为50.2戈伊。内乳区域的覆盖范围是实质上更好的两个小波束技术比分段阻断技术。与9场子束和分段技术相比，切向子束IMRT技术减少了对正常组织的暴露，并保持了合理的靶区覆盖。
To establish optimal intensity-modulated radiation therapy (IMRT) techniques for treating the left breast and regional nodes, using moderate deep-inspiration breath hold. We developed four IMRT plans of differing complexity for each of 10 patients following lumpectomy for left breast cancer. A dose of 60 Gy was prescribed to the boost planning target volume (PTV) and 52.2 Gy to the breast and supraclavicular, infraclavicular, and internal mammary nodes. Two plans used inverse-planned beamlet techniques: a 9-field technique, with nine equispaced axial beams, and a tangential beamlet technique, with three to five ipsilateral beams. The third plan (a segmental technique) used a forward-planned multi-segment technique, and the fourth plan (a segmental blocked technique) was identical but included a block to limit heart dose. Dose–volume histograms were generated, and metrics chosen for comparison were analyzed using the paired t test. Mean heart and left anterior descending coronary artery doses were similar with the tangential beamlet and segmental blocked techniques but higher with the segmental and 9-field techniques (mean paired difference of 15.1 Gy between segmental and tangential beamlet techniques, p < 0.001). Substantial volumes of contralateral tissue received dose with the 9-field technique (mean right breast V2, 58.9%; mean right lung V2, 75.3%). Minimum dose to ≥95% of breast PTV was, on average, 45.9 Gy with tangential beamlet, 45.0 Gy with segmental blocked, 51.4 Gy with segmental, and 50.2 Gy with 9-field techniques. Coverage of the internal mammary region was substantially better with the two beamlet techniques than with the segmental blocked technique. Compared to the 9-field beamlet and segmental techniques, a tangential beamlet IMRT technique reduced exposure to normal tissues and maintained reasonable target coverage.
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发表时间：
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影响因子：
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