Chan Tabitha Y, Tan Poh Wee, Tang Johann I
Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore.
Breast Cancer (Dove Med Press). 2017 Mar 20;9:177-183. doi: 10.2147/BCTT.S127583. eCollection 2017.
Whole breast external beam radiotherapy (WBEBRT) is commonly used as an essential arm in the treatment management of women with early-stage breast cancer. Dosimetry planning for conventional WBEBRT typically involves a pair of tangential fields. Advancement in radiation technology and techniques has the potential to improve treatment outcomes with clinically meaningful long-term benefits. However, this advancement must be balanced with safety and improved efficacy. Intensity-modulated radiation therapy (IMRT) is an advanced technique that shows promise in improving the planning process and radiation delivery. Early data on utilizing IMRT for WBEBRT demonstrate more homogenous dose distribution with reduction in organs at risk doses. This translates to toxicities reduction. The two common descriptors for IMRT are forward-planning "fields in field" and inverse planning. Unlike IMRT for other organs, the aim of IMRT for breast planning is to achieve dose homogeneity and not organ conformality. The aim of this paper was to evaluate whether IMRT is ready for prime time based on these three points: 1) workload impact, 2) the clinical impact on the patient's quality of life, and 3) the appropriateness and applicability to clinical practice.
全乳外照射放疗（WBEBRT）通常作为早期乳腺癌女性治疗方案中的重要组成部分。传统WBEBRT的剂量学规划通常涉及一对切线野。放射技术和技巧的进步有可能改善治疗效果并带来具有临床意义的长期益处。然而，这种进步必须与安全性和疗效的提高相平衡。调强放疗（IMRT）是一种先进技术，在改善规划过程和放射治疗方面显示出前景。利用IMRT进行WBEBRT的早期数据表明，剂量分布更均匀，危及器官的剂量降低。这意味着毒性降低。IMRT的两个常见描述是正向规划“野中野”和逆向规划。与其他器官的IMRT不同，乳腺规划的IMRT目标是实现剂量均匀性而非器官适形性。本文的目的是基于以下三点评估IMRT是否已准备好广泛应用：1）工作量影响；2）对患者生活质量的临床影响；3）在临床实践中的适用性和实用性。
