Warszawski Antje, Baumann Rolf, Karstens Johann H
Department of Radiotherapy and Special Oncology, Medical University Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
J Clin Ultrasound. 2004 Sep;32(7):333-7. doi: 10.1002/jcu.20050.
This study was conducted to determine the feasibility of using sonography for electron boost planning in breast cancer treatment and to define the factors that influence the accuracy and reproducibility of this technique.
Seventy-seven patients underwent 102 sonographic examinations after breast-conserving surgery and before and after radiotherapy. The size of the electron boost field was defined by measuring the postoperative cavity. Reproducibility of the sonographic findings was investigated in 25 of the patients who were examined before and after radiotherapy (at a total dose of 46-50.4 Gy). Depth (distance from the skin surface to the posterior aspect of the postoperative cavity) was measured, and sonographic appearance of the postoperative cavity was evaluated. Type of surgical procedure, time elapsed since surgery, use of systemic therapy, menopausal status, breast size, and radiation dose were investigated for their influence on sonographic appearance and visualization of the postoperative cavity.
The postoperative cavity was well visualized in 78% of patients and visualized with some difficulty in 22%. In all but 5 patients, it was hypoechoic and inhomogeneous. The mean depth of the postoperative cavity after radiotherapy was 27 +/- 4 mm. Smaller breast (p < 0.001) and younger age (p < 0.05) were associated with decreased visibility of the postoperative cavity. Sonographic appearance was the same before and after radiotherapy, but the mean difference in postoperative cavity depth between the 2 measurements was 2 mm (range, 0-4 mm). In 43/77 (56%) of the patients, changes in electron energy or in field size were required after sonographic measurement.
Sonography is a useful and reproducible means of electron boost planning, helping to avoid underdosage of the postoperative cavity and overdosage of normal tissue.
本研究旨在确定超声检查在乳腺癌治疗电子束追加计划中的可行性，并明确影响该技术准确性和可重复性的因素。
77例患者在保乳手术后、放疗前后接受了102次超声检查。通过测量术后腔隙来确定电子束追加野的大小。对25例放疗前后接受检查（总剂量46 - 50.4 Gy）的患者进行超声检查结果可重复性研究。测量深度（从皮肤表面到术后腔隙后壁的距离），并评估术后腔隙的超声表现。研究手术方式、术后时间、全身治疗的使用、绝经状态、乳房大小和放疗剂量对术后腔隙超声表现及可视化的影响。
78%的患者术后腔隙显示良好，22%的患者显示有一定困难。除5例患者外，其余所有患者的术后腔隙均为低回声且不均匀。放疗后术后腔隙的平均深度为27±4 mm。乳房较小（p < 0.001）和年龄较轻（p < 0.05）与术后腔隙可见度降低相关。放疗前后超声表现相同，但两次测量的术后腔隙深度平均差异为2 mm（范围0 - 4 mm）。43/77（56%）的患者在超声测量后需要调整电子能量或野大小。
超声检查是电子束追加计划的一种有用且可重复的方法，有助于避免术后腔隙剂量不足和正常组织剂量过量。
