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包括Ⅰ级和Ⅱ级淋巴结的选择性乳腺放疗：以肱骨头作为计划风险体积的一项计划研究。

Elective breast radiotherapy including level I and II lymph nodes: A planning study with the humeral head as planning risk volume.

作者信息

Surmann Kathrin, van der Leer Jorien, Branje Tammy, van der Sangen Maurice, van Lieshout Maarten, Hurkmans Coen W

机构信息

Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.

出版信息

Radiat Oncol. 2017 Jan 18;12(1):22. doi: 10.1186/s13014-016-0759-7.

DOI:10.1186/s13014-016-0759-7
PMID:28100239
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5241955/
Abstract

BACKGROUND

The aim of this study was to assess the dose to the humeral head planning risk volume with the currently used high tangential fields (HTF) and compare different planning techniques for breast radiotherapy including axillary level I and II lymph nodes (PTVn) while sparing the humeral head.

METHODS

Ten patients with left-sided breast cancer were enrolled in a planning study with 16 fractions of 2.66 Gy. Four planning techniques were compared: HTF, HTF with sparing of the humeral head, 6-field IMRT with sparing of the humeral head and VMAT with sparing of the humeral head. The humeral head + 10 mm was spared by restricting V40Gy < 1 cc.

RESULTS

The dose to the humeral head was too high with HTF (V40Gy on average 20.7 cc). When sparing the humeral head in HTF, PTVn V90% decreased significantly from 97.9% to 89.4%. 6-field IMRT and VMAT had a PTVn V90% of 98.2% and 99.5% respectively. However, dose to the lungs, heart and especially the contralateral breast increased with VMAT.

CONCLUSIONS

The humeral head is rarely spared when using HTF. When sparing the humeral head, the 6-field IMRT technique leads to adequate PTV coverage while not increasing the dose to the OARs.

摘要

背景

本研究的目的是评估使用当前常用的高切线野（HTF）时肱骨头计划风险体积所接受的剂量，并比较包括腋窝Ⅰ级和Ⅱ级淋巴结（PTVn）的乳腺癌放疗的不同计划技术，同时保护肱骨头。

方法

10例左侧乳腺癌患者参与了一项计划研究，给予16次分割，每次2.66 Gy。比较了四种计划技术：HTF、保护肱骨头的HTF、保护肱骨头的6野调强放疗（IMRT）和保护肱骨头的容积旋转调强放疗（VMAT）。通过限制V40Gy＜1 cc来保护肱骨头+10 mm。

结果

HTF时肱骨头接受的剂量过高（V40Gy平均为20.7 cc）。在HTF中保护肱骨头时，PTVn的V90%从97.9%显著降至89.4%。6野IMRT和VMAT的PTVn的V90%分别为98.2%和99.5%。然而，VMAT使肺、心脏尤其是对侧乳腺接受的剂量增加。

结论

使用HTF时很少能保护肱骨头。在保护肱骨头时，6野IMRT技术可实现对PTV的充分覆盖，同时不会增加危及器官的剂量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f50/5241955/6a81b934878b/13014_2016_759_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f50/5241955/4b74c3b7208f/13014_2016_759_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f50/5241955/ad5ce55d1d8c/13014_2016_759_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f50/5241955/243548aede0f/13014_2016_759_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f50/5241955/6a81b934878b/13014_2016_759_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f50/5241955/4b74c3b7208f/13014_2016_759_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f50/5241955/ad5ce55d1d8c/13014_2016_759_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f50/5241955/243548aede0f/13014_2016_759_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f50/5241955/6a81b934878b/13014_2016_759_Fig4_HTML.jpg

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