Gorken I B, Bayman E D, Balci P, Bakis B, Karaguler Z, Isman B D, Kinay M
Dokuz Eylul University, Medical Faculty, Department of Radiation Oncology, Izmir, Turkey.
J BUON. 2010 Jul-Sep;15(3):500-3.
To compare ultrasonographic (US) with computerized tomographic (CT) images in order to choose electron energy for radiotherapy (RT) boost field in patients with breast conserving surgery (BCS).
Thirty-seven consecutive patients with breast cancer treated by BCS and RT in our department were evaluated. Median age was 49 years (range 32-82). According to the Dokuz Eylul Breast Tumor Group Protocol (DEBTG), in patients with BCS, RT (5000 cGy to the whole breast ± lymphatic area) and boost with electron energy to the primary tumor bed (1000 cGy if surgical margin negative, or 1600 cGy if surgical margin positive was delivered. Before January 2003, the distances between skin-the deepest point of tumor bed (STD), skin-clips (SCD), and skin-fascia (SFD) were measured with US to choose electron energy in boost field. Since then, CT simulation images were used to this purpose. These two imaging systems were compared in this study. Electron energy was selected after measurement of the deepest metallic clips in CT simulation images (90%) or measurement of the STD if no clips were present (10%).
Median measurements with US and CT were as follows: STD: US 12 mm (range 4-35), CT 28 mm (range 2-54); SFD: US 25 mm (range 6-57), CT 31 mm (range 2-93); SCD: US 14 mm (range 7-26), CT 29 mm (range 2-68). The median electron energy was 9 MeV é (range 6-12) for US and 12 MeV é (range 6-21) for CT. Concordance in US and CT measurements was 27%.
This preliminary study reveals that CT-based SCD measurements are deeper than US measurements, and selected electron energy with CT is 3 MeV higher than US. These two factors can affect local control and side effects. We noticed only one local recurrence in 37 patients. We did not evaluate side effects in this study. These could be a subject of a future study.
比较超声（US）与计算机断层扫描（CT）图像，以便为保乳手术（BCS）患者的放疗（RT）加量野选择电子能量。
对我院37例接受BCS和RT治疗的连续乳腺癌患者进行评估。中位年龄49岁（范围32 - 82岁）。根据多库兹艾吕尔乳腺肿瘤组方案（DEBTG），对于BCS患者，给予全乳±淋巴区域5000 cGy的RT，并对原发肿瘤床给予电子能量加量（手术切缘阴性时为1000 cGy，手术切缘阳性时为1600 cGy）。2003年1月之前，通过US测量皮肤-肿瘤床最深点（STD）、皮肤-夹子（SCD）和皮肤-筋膜（SFD）之间的距离，以选择加量野的电子能量。从那时起，使用CT模拟图像进行此操作。本研究对这两种成像系统进行了比较。在CT模拟图像中测量最深金属夹后（90%）或无夹子时测量STD（10%）来选择电子能量。
US和CT的中位测量值如下：STD：US为12 mm（范围4 - 35），CT为28 mm（范围2 - 54）；SFD：US为25 mm（范围6 - 57），CT为31 mm（范围2 - 93）；SCD：US为14 mm（范围7 - 26），CT为29 mm（范围2 - 68）。US的中位电子能量为9 MeVé（范围6 - 12），CT的中位电子能量为12 MeVé（范围6 - 21）。US和CT测量的一致性为27%。
这项初步研究表明，基于CT的SCD测量比US测量更深，且CT选择的电子能量比US高3 MeV。这两个因素可能会影响局部控制和副作用。我们在37例患者中仅注意到1例局部复发。本研究未评估副作用。这些可能是未来研究的主题。
