背景:ESTRO-ACROP共识指南(EACG)推荐了基于植入物的即时乳房重建(IBR)后乳房切除术后放疗的排除临床目标体积(CTVp)定义。这项研究的目的是研究螺旋断层疗法(HTp)和体积调制电弧疗法(VMATp)治疗技术在CTVp覆盖率和降低器官风险(OAR)方面的有效性,当CTVp用于治疗计划而不是常规CTV时,正常组织和植入物剂量。
方法:本研究包括8名在乳房切除术后接受IBR的左侧和右侧乳腺癌患者。在自由呼吸期间获取计划CT数据集,并使用针对常规CTV的HT技术对患者进行治疗。回顾过去,CTVp是由同一位放射肿瘤学家根据EACG描绘的,并基于CTVp生成HTp和VMATp技术的治疗计划。对于每个病人来说,从三种不同的治疗方案中获得相关剂量学参数.
结果:目标覆盖率在以下方面没有统计学上的显着差异:PTVp-D95,PTVp-Vpres,HTp和VMATp计划的同质性指数(p>0.05)。但是,符合数量明显更高(HTp与VMATp,VMATp为0.69±0.15vs0.79±0.12(Z=-2.17,p=0.030)。虽然HTp显著降低了LAD的Dmax和Dmean(LAD-Dmax:χ2=12.25,p=0.002,LAD-Dmean:χ2=12.30,p=0.002),HTp和VMATp均不能降低心脏的最大和平均剂量(p>0.05)。此外,与HTp相比,VMATp接受5Gy的心脏体积显著高于HTp(21.2±9.8vs42.7±24.8,p:0.004).两种技术都成功地降低了植入的平均剂量(HTp与HT,p<0.001;VMATp与HT,p<0.001;VMATp与HTp,p=0.005)。
结论:HTp和VMATp技术均成功获得了CTVp内的适形和均匀剂量分布,同时降低了平均植入剂量。发现HTp在降低除CB外的所有OAR剂量方面优于VMATp。
BACKGROUND: The ESTRO-ACROP
Consensus Guideline (EACG) recommends implant excluded clinical target volume (CTVp) definitions for post-mastectomy radiation therapy after implant-based immediate breast reconstruction (IBR). The purpose of this study is to investigate the effectiveness of Helical Tomotherapy (HTp) and Volumetric Modulated Arc Therapy (VMATp) treatment techniques in terms of CTVp coverage and reduced organ at risk (OAR), normal tissue and implant doses when CTVp was used for treatment planning as the target structure instead of conventional CTV.
METHODS: Eight left-sided and eight right-sided breast cancer patients who underwent IBR after mastectomy were included in this study. Planning CT data sets were acquired during free breathing and patients were treated with HT technique targeted to conventional CTV. Retrospectively, CTVp was delineated based on EACG by the same radiation oncologist, and treatment plans with HTp and VMATp techniques were generated based on CTVp. For each patient, relevant dosimetric parameters were obtained from three different treatment plans.
RESULTS: There was no statistically significant difference on target coverage in terms of, PTVp-D95, PTVp-Vpres, homogeneity index (p > 0.05) between HTp and VMATp plans. But, the conformity numbers were significantly higher (HTp vs VMATp, 0.69 ± 0.15 vs 0.79 ± 0.12) for VMATp (Z = - 2.17, p = 0.030). While HTp significantly lowered Dmax and Dmean for LAD (LAD-Dmax: χ2 = 12.25, p = 0.002 and LAD-Dmean: χ2 = 12.30, p = 0.002), neither HTp nor VMATp could reduce maximum and mean dose to heart (p > 0.05). Furthermore, heart volume receiving 5 Gy was significantly higher for VMATp when compared to HTp (21.2 ± 9.8 vs 42.7 ± 24.8, p: 0.004). Both techniques succeeded in reducing the mean dose to implant (HTp vs HT, p < 0.001; VMATp vs HT, p < 0.001; VMATp vs HTp, p = 0.005).
CONCLUSIONS: Both HTp and VMATp techniques succeeded to obtain conformal and homogeneous dose distributions within CTVp while reducing the mean implant dose. HTp was found to be superior to VMATp with regards to lowering all OAR doses except for CB.