Sakyanun Pitchaya, Saksornchai Kitwadee, Nantavithya Chonnipa, Chakkabat Chakkapong, Shotelersuk Kanjana
Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Radiat Oncol J. 2020 Sep;38(3):181-188. doi: 10.3857/roj.2020.00094. Epub 2020 Sep 22.
To determine the effect of the deep inspiration breath-hold (DIBH) technique on left anterior descending coronary artery (LAD) region and heart dose in left breast cancer irradiation.
Twenty-five left breast cancer patients who previously received breast-conserving surgery underwent computed tomography (CT) simulation with both free-breathing (FB) and DIBH techniques and four radiation treatment plans. The plan comprised the following with both the FB and DIBH techniques: whole breast (WB), and WB with internal mammary lymph nodes (WB+IMNs). The prescription dose was 50 Gy in 25 fractions. The doses to the LAD region, heart and lungs were compared. Moreover, in-field maximum heart distance (maxHD) and breast volume were analyzed for correlations with the mean heart dose (MHD).
In the WB plan with DIBH vs. FB techniques, the mean radiation doses to the LAD region, MHD, and the left lung V20 were 11.48 Gy vs. 19.84 Gy (p < 0.0001), 2.95 Gy vs. 5.38 Gy (p < 0.0001), and 19.72% vs. 22.73% (p = 0.0045), respectively. In the WB+IMNs plan, the corresponding values were 23.88 Gy vs. 31.98 Gy (p < 0.0001), 6.43 Gy vs. 10.24 Gy (p < 0.0001), and 29.31% vs. 32.1% (p = 0.0009), respectively. MHD correlated with maxHD (r = 0.925) and breast volume (r = 0.6).
The use of the DIBH technique in left breast cancer irradiation effectively reduces the radiation doses to the LAD region, heart and lungs. MHD is associated with maxHD and breast size.
确定深吸气屏气（DIBH）技术对左乳腺癌放疗中左前降支冠状动脉（LAD）区域及心脏剂量的影响。
25例曾接受保乳手术的左乳腺癌患者接受了自由呼吸（FB）和DIBH技术的计算机断层扫描（CT）模拟以及四个放射治疗计划。该计划在FB和DIBH技术下均包括：全乳（WB），以及全乳加内乳淋巴结（WB + IMNs）。处方剂量为50 Gy，分25次给予。比较了LAD区域、心脏和肺部的剂量。此外，分析了射野内最大心脏距离（maxHD）和乳房体积与平均心脏剂量（MHD）的相关性。
在WB计划中，与FB技术相比，DIBH技术下LAD区域的平均放射剂量、MHD以及左肺V20分别为11.48 Gy对19.84 Gy（p < 0.0001）、2.95 Gy对5.38 Gy（p < 0.0001）以及19.72%对22.73%（p = 0.0045）。在WB + IMNs计划中，相应值分别为23.88 Gy对31.98 Gy（p < 0.0001）、6.43 Gy对10.24 Gy（p < 0.0001）以及29.31%对32.1%（p = 0.0009）。MHD与maxHD（r = 0.925）和乳房体积（r = 0.6）相关。
在左乳腺癌放疗中使用DIBH技术可有效降低LAD区域、心脏和肺部的放射剂量。MHD与maxHD和乳房大小有关。
