DeWyngaert J Keith, Jozsef Gabor, Mitchell James, Rosenstein Barry, Formenti Silvia C
Department of Radiation Oncology, New York University School of Medicine, 160 E. 34th Street, New York, NY 10016, USA.
Int J Radiat Oncol Biol Phys. 2007 Jul 15;68(4):1251-9. doi: 10.1016/j.ijrobp.2007.04.018.
To report the physics and dosimetry results of a trial of accelerated intensity-modulated radiotherapy to the whole breast with a concomitant boost to the tumor bed in patients treated in the prone position.
Patients underwent computed tomography planning and treatment in the prone position on a dedicated treatment platform. The platform has an open aperture on the side to allow for the index breast to fall away from the chest wall. Noncontrast computed tomography images were acquired at 2.5- or 3.75-mm-thick intervals, from the level of the mandible to below the diaphragm. A dose of 40.5 Gy was delivered to the entire breast at 2.7-Gy fractions in 15 fractions. An additional dose of 0.5 Gy was delivered as a concomitant boost to the lumpectomy site, with a 1-cm margin, using inverse planning, for a total dose of 48 Gy in 15 fractions. No more than 10% of the heart and lung volume was allowed to receive >18 and >20 Gy, respectively.
Between September 2003 and August 2005, 91 patients were enrolled in the study. The median volume of heart that received > or =18 Gy was 0.5%, with a maximal value of 4.7%. The median volume of ipsilateral lung that received > or =20 Gy was 0.8%, with a maximum of 7.2%.
This technique for whole breast radiotherapy is feasible and enables an accelerated regimen in the prone position while sparing the lung and heart.
报告对俯卧位患者进行全乳加速调强放疗并同步推量至瘤床的物理和剂量学结果。
患者在专用治疗平台上俯卧位进行计算机断层扫描模拟定位和治疗。该平台一侧有开口，使患侧乳房能垂离胸壁。从下颌骨水平至膈肌下方，以2.5或3.75毫米层厚间隔采集非增强计算机断层扫描图像。全乳给予40.5 Gy剂量，分15次，每次2.7 Gy。使用逆向计划，对保乳手术部位同步推量0.5 Gy，外放1厘米边界，15次总剂量达48 Gy。心脏和肺体积分别不超过10%接受超过18 Gy和20 Gy的剂量。
2003年9月至2005年8月，91例患者入组本研究。接受≥18 Gy剂量的心脏体积中位数为0.5%，最大值为4.7%。接受≥20 Gy剂量的同侧肺体积中位数为0.8%，最大值为7.2%。
这种全乳放疗技术可行，能在俯卧位实现加速放疗方案，同时保护心脏和肺。
