Vicini Frank A, Sharpe Michael, Kestin Larry, Martinez Alvaro, Mitchell Christina K, Wallace Michelle F, Matter Richard, Wong John
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Int J Radiat Oncol Biol Phys. 2002 Dec 1;54(5):1336-44. doi: 10.1016/s0360-3016(02)03746-x.
To present our clinical experience using intensity-modulated radiation therapy (IMRT) to improve dose uniformity and treatment efficacy in patients with early-stage breast cancer treated with breast-conserving therapy.
A total of 281 patients with Stage 0, I, and II breast cancer treated with breast-conserving therapy received whole breast RT after lumpectomy using our static, multileaf collimator (sMLC) IMRT technique. The technical and practical aspects of implementing this technique on a large scale in the clinic were analyzed. The clinical outcome of patients treated with this technique was also reviewed.
The median time required for three-dimensional alignment of the tangential fields and dosimetric IMRT planning was 40 and 45 min, respectively. The median number of sMLC segments required per patient to meet the predefined dose-volume constraints was 6 (range 3-12). The median percentage of the treatment given with open fields (no sMLC segments) was 83% (range 38-96%), and the median treatment time was <10 min. The median volume of breast receiving 105% of the prescribed dose was 11% (range 0-67.6%). The median breast volume receiving 110% of the prescribed dose was 0% (range 0-39%), and the median breast volume receiving 115% of the prescribed dose was also 0%. A total of 157 patients (56%) experienced Radiation Therapy Oncology Group Grade 0 or I acute skin toxicity; 102 patients (43%) developed Grade II acute skin toxicity and only 3 (1%) experienced Grade III toxicity. The cosmetic results at 12 months (95 patients analyzable) were rated as excellent/good in 94 patients (99%). No skin telengiectasias, significant fibrosis, or persistent breast pain was noted.
The use of intensity modulation with our sMLC technique for tangential whole breast RT is an efficient method for achieving a uniform and standardized dose throughout the whole breast. Strict dose-volume constraints can be readily achieved resulting in both uniform coverage of breast tissue and a potential reduction in acute and chronic toxicities. Because the median number of sMLC segments required per patient is only 6, the treatment time is equivalent to conventional wedged-tangent treatment techniques. As a result, widespread implementation of this technology can be achieved with minimal imposition on clinic resources and time constraints.
介绍我们使用调强放射治疗（IMRT）改善保乳治疗的早期乳腺癌患者剂量均匀性和治疗效果的临床经验。
共有281例接受保乳治疗的0期、I期和II期乳腺癌患者在肿块切除术后使用我们的静态多叶准直器（sMLC）IMRT技术接受全乳放疗。分析了在临床大规模实施该技术的技术和实际方面。还回顾了接受该技术治疗患者的临床结果。
切线野三维对准和剂量学IMRT计划所需的中位时间分别为40分钟和45分钟。为满足预定义的剂量体积限制，每位患者所需的sMLC段数中位数为6（范围3 - 12）。开放野（无sMLC段）治疗的中位百分比为83%（范围38 - 96%），中位治疗时间<10分钟。接受规定剂量105%的乳腺中位体积为11%（范围0 - 67.6%）。接受规定剂量110%的乳腺中位体积为0%（范围0 - 39%），接受规定剂量115%的乳腺中位体积也为0%。共有157例患者（56%）经历放射肿瘤学组0级或I级急性皮肤毒性；102例患者（43%）出现II级急性皮肤毒性，只有3例（1%）经历III级毒性。12个月时的美容效果（95例可分析）在94例患者（99%）中被评为优秀/良好。未观察到皮肤毛细血管扩张、明显纤维化或持续性乳房疼痛。
使用我们的sMLC技术进行切线全乳放疗的调强是一种在整个乳房实现均匀和标准化剂量的有效方法。可以轻松实现严格的剂量体积限制，从而既实现乳腺组织的均匀覆盖，又可能降低急性和慢性毒性。由于每位患者所需的sMLC段数中位数仅为6，治疗时间与传统楔形切线治疗技术相当。因此，该技术可以在对临床资源和时间限制影响最小的情况下广泛实施。
