多导管间质近距离放疗与 CyberKnife 立体定向放疗加速部分乳腺照射的比较：一项关于危及器官剂量学的治疗计划研究。
Multicatheter interstitial brachytherapy versus stereotactic radiotherapy with CyberKnife for accelerated partial breast irradiation: a comparative treatment planning study with respect to dosimetry of organs at risk.
机构信息
National Institute of Oncology, Radiotherapy Centre, Budapest, Hungary.
Budapest University of Technology and Economic, Institute of Nuclear Techniques, Budapest, Hungary.
出版信息
Radiol Oncol. 2021 Mar 25;55(2):229-239. doi: 10.2478/raon-2021-0016.
BACKGROUND
The aim of the study was to dosimetrically compare multicatheter interstitial brachytherapy (MIBT) and stereotactic radiotherapy with CyberKnife (CK) for accelerated partial breast irradiation (APBI) especially concerning the dose of organs at risk (OAR-s).
PATIENTS AND METHODS
Treatment plans of thirty-two MIBT and CK patients were compared. The OAR-s included ipsilateral non-target and contralateral breast, ipsilateral and contralateral lung, skin, ribs, and heart for left-sided cases. The fractionation was identical (4 x 6.25 Gy) in both treatment groups. The relative volumes (e.g. V100, V90) receiving a given relative dose (100%, 90%), and the relative doses (e.g. D0.1cm, D1cm) delivered to the most exposed small volumes (0.1 cm, 1 cm) were calculated from dose-volume histograms. All dose values were related to the prescribed dose (25 Gy).
RESULTS
Regarding non-target breast CK performed slightly better than MIBT (V100: 0.7% . 1.6%, V50: 10.5% . 12.9%). The mean dose of the ipsilateral lung was the same for both techniques (4.9%), but doses irradiated to volume of 1 cm were lower with MIBT (36.1% . 45.4%). Protection of skin and rib was better with MIBT. There were no significant differences between the dose-volume parameters of the heart, but with MIBT, slightly larger volumes were irradiated by 5% dose (V5: 29.9% . 21.2%). Contralateral breast and lung received a somewhat higher dose with MIBT (D1cm: 2.6% . 1.8% and 3.6% . 2.5%).
CONCLUSIONS
The target volume can be properly irradiated by both techniques with similar dose distributions and high dose conformity. Regarding the dose to the non-target breast, heart, and contralateral organs the CK was superior, but the nearby organs (skin, ribs, ipsilateral lung) received less dose with MIBT. The observed dosimetric differences were small but significant in a few parameters at the examined patient number. More studies are needed to explore whether these dosimetric findings have clinical significance.
背景
本研究旨在通过比较多导管间质近距离放射治疗（MIBT）和立体定向放射治疗（CyberKnife，CK）在加速部分乳房照射（APBI）中的剂量学，尤其是在危及器官（OAR-s）剂量方面。
方法
比较了 32 例 MIBT 和 CK 患者的治疗计划。OAR-s 包括同侧非靶区和对侧乳房、同侧和对侧肺、皮肤、肋骨和心脏（左侧病例）。两组的分割方式相同（4×6.25 Gy）。从剂量体积直方图中计算出给定相对剂量（100%、90%）的相对体积（如 V100、V90），以及最暴露的小体积（0.1 cm、1 cm）的相对剂量（如 D0.1cm、D1cm）。所有剂量值均与处方剂量（25 Gy）相关。
结果
对于非靶区乳房，CK 略优于 MIBT（V100：0.7%比 1.6%，V50：10.5%比 12.9%）。两种技术的同侧肺平均剂量相同（4.9%），但 MIBT 照射 1 cm 体积的剂量较低（36.1%比 45.4%）。MIBT 对皮肤和肋骨的保护更好。心脏的剂量体积参数无显著差异，但 MIBT 照射的 5%剂量体积稍大（V5：29.9%比 21.2%）。MIBT 对同侧乳房和肺的照射剂量略高（D1cm：2.6%比 1.8%和 3.6%比 2.5%）。
结论
两种技术均可通过相似的剂量分布和高剂量适形性对靶区进行适当照射。在非靶区乳房、心脏和对侧器官的剂量方面，CK 优于 MIBT，但 MIBT 照射的邻近器官（皮肤、肋骨、同侧肺）剂量较低。在检查的患者数量中，一些参数观察到的剂量学差异较小但有统计学意义。需要进一步研究以探讨这些剂量学发现是否具有临床意义。
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