Mason Nicole, Macfarlane Deborah, Guidi Robyn, Owen Rebecca, Poulsen Michael
Radiation Therapy Services, Princess Alexandra Hospital, Radiation Oncology Mater Centre, Brisbane, Queensland, Australia.
J Med Imaging Radiat Oncol. 2012 Jun;56(3):362-7. doi: 10.1111/j.1754-9485.2012.02389.x. Epub 2012 May 22.
Radiation therapy to women with large pendulous breasts presents dosimetric challenges when the whole breast (WB) and supraclavicular and axillary (SCF + AX) nodes need to be encompassed. The aim of this case study was to demonstrate the feasibility of planning and treating a pendulous breasted patient in the prone position. Computerised tomography (CT) images were acquired of the patient in both the prone and supine positions. A Perspex plate was added to the CDR Systems Inc. (Calgary, Canada) prone breastboard to minimize SCF + AX contour variations. Dosimetry was performed on both CT scans and the resultant treatment plans were evaluated for conformity, homogeneity, dose to the lung and maximum doses to the spinal cord (SC) and irradiated volume. The daily set-up in the prone position was monitored for stability and reproducibility. The patient completed her treatment course in the prone position. Minimal daily interventions were required to ensure the position was reproduced. Grade 3 skin toxicity was recorded in the SCF + AX region where the Perspex plate was added to the prone positioning device. There was minimal difference in dosimetry between prone and supine plans in the SCF + AX region. The prone WB plan showed improved homogeneity (prone 0.15; supine 0.22) and conformity (prone 0.90; supine 0.77). A simple addition to the breastboard has enabled a pendulous breasted woman with SC + AX involvement to be treated in the prone position. Set-up of this technique is achievable on a daily basis with minimal impact on workflow. It is a feasible alternative to supine treatment for this patient group.
对于乳房下垂的女性进行放射治疗时，如果需要涵盖整个乳房（WB）以及锁骨上和腋窝（SCF + AX）淋巴结，会面临剂量测定方面的挑战。本病例研究的目的是证明在俯卧位对乳房下垂患者进行计划和治疗的可行性。对患者的俯卧位和仰卧位均进行了计算机断层扫描（CT）图像采集。在加拿大卡尔加里的CDR Systems Inc.俯卧式乳房板上添加了一块有机玻璃平板，以尽量减少SCF + AX轮廓的变化。对两次CT扫描均进行了剂量测定，并对所得治疗计划的适形性、均匀性、肺部剂量、脊髓（SC）的最大剂量以及照射体积进行了评估。监测了俯卧位的每日摆位的稳定性和可重复性。患者在俯卧位完成了整个治疗过程。为确保摆位可重复，所需的日常干预极少。在添加了有机玻璃平板的俯卧位定位装置的SCF + AX区域记录到3级皮肤毒性。SCF + AX区域的俯卧位和仰卧位计划在剂量测定方面差异极小。俯卧位的WB计划显示出更好的均匀性（俯卧位0.15；仰卧位0.22）和适形性（俯卧位0.90；仰卧位0.77）。对乳房板进行的一项简单改进，使得一名乳房下垂且伴有SC + AX受累的女性能够在俯卧位接受治疗。该技术的摆位每天都可实现，对工作流程的影响极小。对于该患者群体而言，它是仰卧位治疗的一种可行替代方案。
