PDF(Pubmed)
Abstract：
Left-sided breast cancer radiotherapy can lead to late cardiovascular complications, including ischemic events. To mitigate these risks, cardiac-sparing techniques such as deep-inspiration breath-hold (DIBH) and intensity-modulated radiotherapy (IMRT) have been developed. However, recent studies have shown that mean heart dose is not a sufficient dosimetric parameter for assessing cardiac exposure. In this study, we aimed to compare the radiation exposure to cardiac substructures for ten patients who underwent hypofractionated radiotherapy using DIBH three-dimensional conformal radiation therapy (3DCRT), free-breathing (FB)-3DCRT, and FB helical tomotherapy (HT). Dosimetric parameters of cardiac substructures were analyzed, and the results were statistically compared using the Wilcoxon signed-rank test. This study found a significant reduction in the dose to the heart, left anterior descending coronary artery, and ventricles with DIBH-3DCRT and FB-HT compared to FB-3DCRT. While DIBH-3DCRT was very effective in sparing the heart, in some cases, it provided little or no cardiac sparing. FB-HT can be an interesting treatment modality to reduce the dose to major coronary vessels and ventricles and may be of interest for patients with cardiovascular risks who do not benefit from or cannot perform DIBH. These findings highlight the importance of cardiac-sparing techniques for precise delivery of radiation therapy.
摘要：
左侧乳腺癌放疗可导致晚期心血管并发症，包括缺血事件。为了减轻这些风险，已经开发了保留心脏的技术，例如深吸气屏气（DIBH）和调强放射治疗（IMRT）。然而,最近的研究表明，平均心脏剂量不是评估心脏暴露的足够剂量学参数。在这项研究中,我们旨在比较使用DIBH三维适形放射治疗（3DCRT）接受大分割放射治疗的10例患者对心脏亚结构的辐射暴露，自由呼吸（FB）-3DCRT，和FB螺旋断层疗法（HT）。分析了心脏子结构的剂量学参数，并使用Wilcoxon符号秩检验对结果进行统计学比较。这项研究发现心脏的剂量显着减少，左冠状动脉前降支,与FB-3DCRT相比，DIBH-3DCRT和FB-HT的心室。虽然DIBH-3DCRT在保护心脏方面非常有效，在某些情况下,它提供很少或没有心脏保留。FB-HT可以是一种有趣的治疗方式，可以减少对主要冠状血管和心室的剂量，并且对于没有受益于或不能进行DIBH的心血管风险患者可能会感兴趣。这些发现强调了心脏保留技术对于精确提供放射治疗的重要性。
