Sinacki Marcin, Serkies Krystyna, Dziadziuszko Rafał, Narkowicz Magdalena, Kamińska Joanna, Lipniewicz Joanna
Department of Oncology and Radiotherapy, Medical University of Gdansk.
Department of Oncology and Radiotherapy, Medical University of Gdansk; Institute of Experimental Physics, Faculty of Mathematics, Physics and Informatics, University of Gdansk, Poland.
J Contemp Brachytherapy. 2017 Feb;9(1):7-13. doi: 10.5114/jcb.2017.66043. Epub 2017 Feb 15.
To assess dose received by the left anterior descending (LAD) coronary artery during interstitial pulsed-dose-rate brachytherapy (PDR-BT) boost for left-sided breast cancer patients undergoing organ-sparing treatment.
Thirty consecutive pT1-3N0-1M0 breast cancer patients boosted between 2014 and 2015 with 10 Gy/10 pulses/hour PDR-BT following a computed tomography (CT) simulation with the multi-catheter implant were included. The most common localization of primary tumor were upper quadrants. Patients were implanted with rigid tubes following breast conserving surgery and whole breast external beam irradiation (40 Gy/15 or 50 Gy/25 fractions). Computed tomography scans were retrospectively reviewed and LADs were contoured without and with margin of 5 mm (LAD). Standard treatment plan encompassed tumor bed determined by the surgical clips with margin of 2 cm. Dosimetric parameters were extracted from the dose-volume histograms.
The mean D and V were 10.3 Gy (range: 6.6-13.3), and 42.0 cc (range: 15.3-109.3), respectively. The median dose non-uniformity ratio (DNR) was 0.50 (range: 0.27-0.82). The mean doses to LAD and LAD were 1.0 Gy and 0.96 Gy, and maximal doses were 1.57 Gy and 1.99 Gy, respectively. Dose to the 0.1 cc of the LAD and LAD were 1.42 Gy and 1.85 Gy (range: 0.01-4.98 Gy and 0.1-6.89 Gy), respectively.
Interstitial multi-catheter PDR-BT used as a boost for left-sided breast cancer is generally associated with low dose to the LAD. However, higher dose in individual cases may require alternative approaches.
评估接受保乳治疗的左侧乳腺癌患者在组织间脉冲剂量率近距离放疗（PDR-BT）加量治疗期间左前降支（LAD）冠状动脉所接受的剂量。
纳入2014年至2015年间连续30例pT1-3N0-1M0乳腺癌患者，这些患者在多导管植入的计算机断层扫描（CT）模拟后接受10 Gy/10脉冲/小时的PDR-BT加量治疗。原发肿瘤最常见的定位是上象限。患者在保乳手术和全乳外照射（40 Gy/15分次或50 Gy/25分次）后植入刚性导管。对CT扫描进行回顾性分析，在无5 mm边界（LAD）和有5 mm边界（LAD）的情况下勾勒出LADs。标准治疗计划包括由手术夹确定的肿瘤床，边界为2 cm。从剂量体积直方图中提取剂量学参数。
平均D和V分别为10.3 Gy（范围：6.6-13.3）和42.0 cc（范围：15.3-109.3）。中位剂量不均匀率（DNR）为0.50（范围：0.27-0.82）。LAD和LAD的平均剂量分别为1.0 Gy和0.96 Gy，最大剂量分别为1.57 Gy和1.99 Gy。LAD和LAD的0.1 cc剂量分别为1.42 Gy和1.85 Gy（范围：0.01-4.98 Gy和0.1-6.89 Gy）。
作为左侧乳腺癌加量治疗的组织间多导管PDR-BT通常与LAD的低剂量相关。然而，个别病例中的较高剂量可能需要采用其他方法。
