Latimer James G, Beckham Wayne, West Mark, Holloway Lois, Delaney Geoff
Cancer Therapy Centre, Liverpool Health Service, Liverpool, NSW, Australia.
Med Dosim. 2005 Spring;30(1):31-5. doi: 10.1016/j.meddos.2004.10.006.
Tangential radiotherapy delivered to women with large breasts can be problematic due to the excessive skin folds and the way that the breast falls into the axilla. This may necessitate excessive lung irradiation to cover the posterior part of the breast volume adequately. Conventional breast rings used to move the breast anteriorly can be very difficult to reproduce and may substantially increase the skin dose and hence skin toxicity due to the bolus effect. An in-house designed microshell device was constructed to improve setup reproducibility and minimize skin dose. Dose comparisons using a phantom were made between this device and 2 other commonly used devices. The microshell successfully reduced the surface dose compared to the other breast rings tested. This device was then investigated on 8 patients under clinical conditions. Skin doses measured on the trial patients were within acceptable limits. During this small pilot study, no patients suffered excessive skin toxicity or required treatment breaks. Due to the microshell's expandable nature, ease of application, which increases patient comfort compared to other breast rings, and the lower surface dose, the microshell is the preferred breast stabilization device for this department when treating patients with large pendulous breasts. We encourage other departments to consider their current method of breast stabilization and compare them to our results.
对于乳房较大的女性，切线放射治疗可能会出现问题，因为皮肤褶皱过多以及乳房垂入腋窝的方式。这可能需要对肺部进行过多照射，以充分覆盖乳房体积的后部。用于将乳房向前移动的传统乳房环很难重复使用，并且由于推注效应可能会大幅增加皮肤剂量，进而增加皮肤毒性。构建了一种内部设计的微壳装置，以提高摆位重复性并使皮肤剂量最小化。使用体模对该装置与其他两种常用装置进行了剂量比较。与测试的其他乳房环相比，微壳成功降低了表面剂量。然后在临床条件下对8名患者进行了该装置的研究。试验患者测量的皮肤剂量在可接受范围内。在这项小型试点研究中，没有患者出现过度的皮肤毒性或需要中断治疗。由于微壳具有可扩张的特性、易于应用（与其他乳房环相比可提高患者舒适度）以及较低的表面剂量，因此在治疗乳房下垂较大的患者时，微壳是该科室首选的乳房稳定装置。我们鼓励其他科室考虑其当前的乳房稳定方法，并与我们的结果进行比较。
