Department of Medicine and Healthcare, Møre & Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway.
Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway.
J Appl Clin Med Phys. 2021 Apr;22(4):44-51. doi: 10.1002/acm2.13208. Epub 2021 Feb 27.
The purpose of the in silico study was to compare free breathing volumetric modulated arc therapy (VMAT) to standard deep inspiration breath-hold (DIBH) three-dimensional conformal radiotherapy (3DCRT) and determine whether the former is a viable option for elderly patients with left-sided early stage breast cancer. Data from 22 patients with early-stage left breast carcinoma requiring breast-only radiation therapy were used for this planning study. The robustness of VMAT plans when using the free breathing method was compared to that of standard 3DCRT plans using the DIBH method. The endpoints for evaluation were the target dose coverage as well as doses to the organs-at-risk. The free breathing VMAT plans produced a significantly higher mean dose to the heart and right breast than the DIBH-3DCRT plans. Free breathing VMAT plans resulted in significantly better target coverage than did 3DCRT using DIBH. The external volume that received more than 40 Gy was significantly smaller in the VMAT plans. Free breathing VMAT is a viable alternative to DIBH 3DCRT in elderly patients with a limited life expectancy and in subjects who are unable to perform DIBH. The choice of treatment should be individualized, and all relevant risks ought to be considered.
本研究旨在比较自由呼吸容积旋转调强放疗（VMAT）与标准深吸气屏气（DIBH）三维适形放疗（3DCRT），以评估前者是否适用于预期寿命有限或无法行 DIBH 的老年左侧早期乳腺癌患者。我们对 22 例需行单纯乳房放疗的左侧早期乳腺癌患者进行了这项计划研究。采用 DIBH 法的标准 3DCRT 计划和自由呼吸法的 VMAT 计划的稳健性进行了比较，评价终点包括靶区剂量覆盖和危及器官剂量。与 DIBH-3DCRT 计划相比，自由呼吸 VMAT 计划的心脏和右侧乳房平均剂量明显升高。与采用 DIBH 的 3DCRT 相比，自由呼吸 VMAT 计划能更好地覆盖靶区。VMAT 计划中接受 40Gy 以上剂量的外部体积明显更小。对于预期寿命有限或无法行 DIBH 的老年患者，自由呼吸 VMAT 是 DIBH 3DCRT 的一种可行替代治疗选择。治疗选择应个体化，且应考虑所有相关风险。
