Fournier-Bidoz N, Kirova Y, Campana F, El Barouky J, Zefkili S, Dendale R, Bollet M A, Mazal A, Fourquet A
Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, Paris 75005, France.
J Med Phys. 2009 Jul;34(3):149-52. doi: 10.4103/0971-6203.54849.
Breast conserving radiotherapy uses tangential fields and compensating wedges. This conventional approach can be improved by a field-in-field technique using the linac multi-leaf collimator (MLC). A simplified field-in-field technique that planners can easily achieve and which improves dose uniformity in the breast volume is presented here. Field junction problems are more easily solved by the use of a virtual simulation. A unique isocenter can be set at the junction between the supra-clavicular field and the breast tangential fields. However, careful quality assurance of the treatment planning system must be performed. Tomotherapy has promising clinical advantages: the ability of a tomographic image to correct for random set-up errors, a continuous cranio-caudal delivery which suppresses junction problems, the conformality of the dose distribution throughout the complex volumes formed by the lymph nodes and the breasts. Tomotherapy is a valuable recourse for complex irradiations like bilateral breast or mammary plus axillary irradiation while a field-in-field associated with a unique isocenter technique can be used for majority of the patients.
保乳放疗采用切线野和补偿楔形板。这种传统方法可通过使用直线加速器多叶准直器（MLC）的野中野技术得到改进。本文介绍了一种简化的野中野技术，计划者可轻松实现该技术，且该技术能改善乳腺体积内的剂量均匀性。通过使用虚拟模拟，野交界问题更容易解决。可在锁骨上野与乳腺切线野的交界处设置一个独特的等中心。然而，必须对治疗计划系统进行仔细的质量保证。断层放疗具有有前景的临床优势：断层图像能够校正随机摆位误差、连续的头脚方向照射可抑制交界问题、剂量分布在由淋巴结和乳腺形成的复杂体积内具有适形性。对于双侧乳腺或乳腺加腋窝照射等复杂照射，断层放疗是一种有价值的手段，而对于大多数患者，可使用与独特等中心技术相关的野中野技术。
