Cho B C John, Hurkmans Coen W, Damen Eugene M F, Zijp Lambert J, Mijnheer Ben J
Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Radiother Oncol. 2002 Feb;62(2):127-36. doi: 10.1016/s0167-8140(01)00472-8.
To compare and evaluate intensity modulated (IMRT) and non-intensity modulated radiotherapy techniques in the treatment of the left breast and upper internal mammary lymph node chain.
The breast, upper internal mammary chain (IMC), heart and lungs were delineated on a computed tomography (CT)-scan for 12 patients. Three different treatment plans were created: (1) tangential photon fields with oblique IMC electron-photon fields with manually optimized beam weights and wedges, (2) wide split tangential photon fields with a heart block and computer optimized wedge angles, and (3) IMRT tangential photon fields. For the IMRT technique, an inverse planning program (KonRad) generated the intensity profiles and a clinical three-dimensional treatment planning system (U-MPlan) optimized the segment weights. U-MPlan calculated the dose distribution for all three techniques. The normal tissue complication probabilities (NTCPs) for the organs at risk (ORs) were calculated for comparison.
The average root mean square deviation of the differential dose-volume histogram of the breast planning target volume was 4.6, 3.9 and 3.5% and the average mean dose to the IMC was 97.2, 108.0 and 99.6% for the oblique electron, wide split tangent and IMRT techniques, respectively. The average NTCP for the ORs (i.e. heart and lungs) were comparable between the oblique electron and IMRT techniques (<or=0.7%). The wide split tangent technique resulted in higher NTCP values (>or=2%) for the ORs.
The lowest NTCP values were found with the oblique electron and the IMRT techniques. The IMRT technique had the best breast and IMC target coverage.
比较和评估调强放射治疗（IMRT）与非调强放射治疗技术在左乳及内乳淋巴结链治疗中的效果。
对12例患者的胸部进行计算机断层扫描（CT），勾画出乳房、内乳链（IMC）、心脏和肺部。制定了三种不同的治疗计划：（1）切线光子野联合倾斜IMC电子 - 光子野，手动优化射束权重和楔形板；（2）宽分割切线光子野加心脏挡铅，计算机优化楔形板角度；（3）IMRT切线光子野。对于IMRT技术，使用逆向计划程序（KonRad）生成强度分布，临床三维治疗计划系统（U - MPlan）优化射野权重。U - MPlan计算所有三种技术的剂量分布。计算危及器官（OR）的正常组织并发症概率（NTCP）以进行比较。
对于乳房计划靶体积，倾斜电子、宽分割切线和IMRT技术的剂量 - 体积直方图平均均方根偏差分别为4.6%、3.9%和3.5%，IMC的平均平均剂量分别为97.2%、108.0%和99.6%。倾斜电子和IMRT技术的OR（即心脏和肺部）平均NTCP相当（≤0.7%）。宽分割切线技术导致OR的NTCP值较高（≥2%）。
倾斜电子和IMRT技术的NTCP值最低。IMRT技术对乳房和IMC靶区的覆盖效果最佳。
