Hepp Rodrigo, Ammerpohl Mark, Morgenstern Christina, Nielinger Lisa, Erichsen Patricia, Abdallah Abdallah, Galalae Razvan
Klinik für Strahlentherapie und Radioonkologie, Evangelische Kliniken Gelsenkirchen, Munckelstraße 27, 45879, Gelsenkirchen, Deutschland,
Strahlenther Onkol. 2015 Sep;191(9):710-6. doi: 10.1007/s00066-015-0838-y. Epub 2015 Apr 18.
Adjuvant radiotherapy after breast-conserving surgery (BCS) for breast cancer (BC) is a well-established indication. The risk of ischaemic heart disease after radiotherapy for BC increases linearly with the heart mean dose with no apparent threshold. Radiotherapy to the left breast in deep inspiration breath-hold (DIBH) reduces the dose to the heart. A new linac system with an integrated surface scanner (SS) for DIBH treatments was recently installed in our department. We tested it for potential benefits, safety, patients' acceptance/compliance and associated additional workload.
Twenty consecutive patients following BCS for breast carcinoma of the left side were enrolled in our institutional DIBH protocol. We compared dose to the heart and ipsilateral lung (IL) between plans in DIBH and free breathing (FB) using standard defined parameters: mean dose, maximal dose to a volume of 2 cm(3) (D2 cm (3)), volume receiving ≥ 5 Gy (V5), 10 Gy (V10), 15 Gy (V15) and 20 Gy (V20). Comparison of median calculated dose values was performed using a two-tailed Wilcoxon signed rank test.
DIBH was associated with a statistically significant reduction (p < 0.001) in all studied parameters for the heart and the IL. In 16 of 20 patients the heart D2 cm (3) was less than 42 Gy in DIBH. In FB the heart D2 cm (3) was ≥ 42 Gy in 17 of 20 patients. The median daily treatment time was 9 min.
Radiotherapy of the left breast in DIBH using a SS could easily be incorporated into daily routine and is associated with significant dose reduction to the heart and IL.
乳腺癌保乳手术后的辅助放疗是一项既定的适应症。乳腺癌放疗后缺血性心脏病的风险随心脏平均剂量呈线性增加，且无明显阈值。深吸气屏气（DIBH）下对左乳进行放疗可降低心脏剂量。我们科室最近安装了一种带有集成表面扫描器（SS）的新型直线加速器系统用于DIBH治疗。我们对其潜在益处、安全性、患者接受度/依从性以及相关的额外工作量进行了测试。
连续20例左侧乳腺癌保乳手术后的患者纳入我们机构的DIBH方案。我们使用标准定义参数比较了DIBH和自由呼吸（FB）计划中心脏和同侧肺（IL）所接受的剂量：平均剂量、2 cm³体积的最大剂量（D2 cm³）、接受≥5 Gy（V₅）、10 Gy（V₁₀）、15 Gy（V₁₅）和20 Gy（V₂₀） 的体积。使用双尾Wilcoxon符号秩检验对计算出的中位数剂量值进行比较。
DIBH与心脏和IL所有研究参数在统计学上有显著降低（p < 0.001）相关。20例患者中有16例在DIBH时心脏D2 cm³小于42 Gy。在FB时，20例患者中有17例心脏D2 cm³≥42 Gy。每日中位治疗时间为9分钟。
使用SS在DIBH下对左乳进行放疗可轻松纳入日常工作，并且与心脏和IL的剂量显著降低相关。
