PDF(Sci-hub)
Abstract：
UNASSIGNED: Along with breast-conserving surgery (BCS), adjuvant radiotherapy (RT) of patients with early breast cancer plays a crucial role in the oncologic treatment concept. Conventionally, irradiation is carried out with the aid of tangentially arranged fields. However, more modern and more complex radiation techniques such as IMRT (intensity-modulated radio therapy) are used more frequently, as they improve dose conformity and homogeneity and, in some cases, achieve better protection of adjacent risk factors. The use of this technique has implications for the incidental- and thus unintended- irradiation of adjacent loco regional lymph drainage in axillary lymph node levels I-III and internal mammary lymph nodes (IMLNs). A comparison of a homogeneous \"real-life\" patient collective, treated with helical tomotherapy (TT), patients treated with 3D conformal RT conventional tangentially arranged fields (3DCRT) and deep inspiration breath hold (3DCRT-DIBH), was conducted.
METHODS: This study included 90 treatment plans after BCS, irradiated in our clinic from January 2012 to August 2016 with TT (n = 30) and 3D-CRT (n = 30), 3DCRT DIBH (n = 30). PTVs were contoured at different time points by different radiation oncologists (> 7). TT was performed with a total dose of 50.4 Gy and a single dose of 1.8 Gy with a simultaneous integrated boost (SIB) to the tumor cavity (TT group). Patients irradiated with 3DCRT/3DCRT DIBH received 50 Gy à 2 Gy and a sequential boost. Contouring of lymph drainage routes was performed retrospectively according to RTOG guidelines.
RESULTS: Average doses (DMean) in axillary lymph node Level I/Level II/Level III were 31.6 Gy/8.43 Gy/2.38 Gy for TT, 24.0 Gy/11.2 Gy/3.97 Gy for 3DCRT and 24.7 Gy/13.3 Gy/5.59 Gy for 3DCRT-DIBH patients. Internal mammary lymph nodes (IMLNs) Dmean were 27.8 Gy (TT), 13.5 Gy (3DCRT), and 18.7 Gy (3DCRT-DIBH). Comparing TT to 3DCRT-DIBH dose varied significantly in all axillary lymph node levels and the IMLNs. Comparing TT to 3DCRT significant dose difference in Level I and IMLNs was observed.
CONCLUSIONS: Dose applied to locoregional lymph drainage pathways varies comparing tomotherapy plans to conventional tangentially arranged fields. Studies are warranted whether dose variations influence loco-regional spread and must have implications for target volume definition guidelines.
METHODS: This study included 90 treatment plans after BCS, irradiated in our clinic from January 2012 to August 2016 with TT (n = 30) and 3D-CRT (n = 30), 3DCRT DIBH (n = 30). PTVs were contoured at different time points by different radiation oncologists (> 7). TT was performed with a total dose of 50.4 Gy and a single dose of 1.8 Gy with a simultaneous integrated boost (SIB) to the tumor cavity (TT group). Patients irradiated with 3DCRT/3DCRT DIBH received 50 Gy à 2 Gy and a sequential boost. Contouring of lymph drainage routes was performed retrospectively according to RTOG guidelines.
RESULTS: Average doses (DMean) in axillary lymph node Level I/Level II/Level III were 31.6 Gy/8.43 Gy/2.38 Gy for TT, 24.0 Gy/11.2 Gy/3.97 Gy for 3DCRT and 24.7 Gy/13.3 Gy/5.59 Gy for 3DCRT-DIBH patients. Internal mammary lymph nodes (IMLNs) Dmean were 27.8 Gy (TT), 13.5 Gy (3DCRT), and 18.7 Gy (3DCRT-DIBH). Comparing TT to 3DCRT-DIBH dose varied significantly in all axillary lymph node levels and the IMLNs. Comparing TT to 3DCRT significant dose difference in Level I and IMLNs was observed.
CONCLUSIONS: Dose applied to locoregional lymph drainage pathways varies comparing tomotherapy plans to conventional tangentially arranged fields. Studies are warranted whether dose variations influence loco-regional spread and must have implications for target volume definition guidelines.
摘要：
■除了保乳手术（BCS），早期乳腺癌患者的辅助放疗（RT）在肿瘤治疗理念中起着至关重要的作用。传统上,辐照是在切向排列的场的帮助下进行的。然而,更频繁地使用更现代和更复杂的放射技术，如IMRT（强度调制放射治疗），因为它们提高了剂量的一致性和均匀性，在某些情况下,更好地保护相邻风险因素。该技术的使用对腋窝淋巴结I-III级和乳内淋巴结（IMLN）中相邻的局部区域淋巴引流的意外辐射和非预期辐射具有影响。一个同质的“现实生活”病人集体的比较，用螺旋断层疗法（TT）治疗，接受3D适形RT常规切向排列场（3DCRT）和深吸气屏气（3DCRT-DIBH）治疗的患者，进行了。
方法：本研究包括90个BCS治疗方案，2012年1月至2016年8月在我们的诊所用TT（n=30）和3D-CRT（n=30）照射，3DCRTDIBH(n=30)。PTV在不同的时间点由不同的放射肿瘤学家轮廓化(>7)。TT的总剂量为50.4Gy，单剂量为1.8Gy，同时对肿瘤腔进行整合增强（SIB）（TT组）。接受3DCRT/3DCRTDIBH照射的患者接受50Gyà2Gy并依次加强。根据RTOG指南回顾性地进行了淋巴引流途径的轮廓。
结果：对于TT，腋窝淋巴结I级/II级/III级的平均剂量（DMean）为31.6Gy/8.43Gy/2.38Gy，3DCRT患者为24.0Gy/11.2Gy/3.97Gy，3DCRT-DIBH患者为24.7Gy/13.3Gy/5.59Gy。乳内淋巴结（IMLNs）平均为27.8Gy（TT），13.5Gy(3DCRT),和18.7Gy（3DCRT-DIBH）。比较TT与3DCRT-DIBH剂量在所有腋窝淋巴结水平和IMLN中显着变化。比较TT与3DCRT,在I级和IMLN中观察到显著的剂量差异。
结论：将断层治疗计划与常规切向排列的区域相比，应用于局部淋巴引流途径的剂量各不相同。有必要研究剂量变化是否会影响局部区域传播，并且必须对目标体积定义指南产生影响。
方法：本研究包括90个BCS治疗方案，2012年1月至2016年8月在我们的诊所用TT（n=30）和3D-CRT（n=30）照射，3DCRTDIBH(n=30)。PTV在不同的时间点由不同的放射肿瘤学家轮廓化(>7)。TT的总剂量为50.4Gy，单剂量为1.8Gy，同时对肿瘤腔进行整合增强（SIB）（TT组）。接受3DCRT/3DCRTDIBH照射的患者接受50Gyà2Gy并依次加强。根据RTOG指南回顾性地进行了淋巴引流途径的轮廓。
结果：对于TT，腋窝淋巴结I级/II级/III级的平均剂量（DMean）为31.6Gy/8.43Gy/2.38Gy，3DCRT患者为24.0Gy/11.2Gy/3.97Gy，3DCRT-DIBH患者为24.7Gy/13.3Gy/5.59Gy。乳内淋巴结（IMLNs）平均为27.8Gy（TT），13.5Gy(3DCRT),和18.7Gy（3DCRT-DIBH）。比较TT与3DCRT-DIBH剂量在所有腋窝淋巴结水平和IMLN中显着变化。比较TT与3DCRT,在I级和IMLN中观察到显著的剂量差异。
结论：将断层治疗计划与常规切向排列的区域相比，应用于局部淋巴引流途径的剂量各不相同。有必要研究剂量变化是否会影响局部区域传播，并且必须对目标体积定义指南产生影响。
