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锥形束 CT 频率对辅助乳腺癌放疗中靶区覆盖和危及器官剂量的影响。

Impact of CBCT frequency on target coverage and dose to the organs at risk in adjuvant breast cancer radiotherapy.

机构信息

Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany.

Deutsches Konsortium Für Translationale Krebsforschung (DKTK)-Partner Site Munich, Munich, Germany.

出版信息

Sci Rep. 2021 Aug 30;11(1):17378. doi: 10.1038/s41598-021-96836-0.

DOI:10.1038/s41598-021-96836-0
PMID:34462489
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8405651/
Abstract

The current study aims to assess the effect of cone beam computed tomography (CBCT) frequency during adjuvant breast cancer radiotherapy with simultaneous integrated boost (SIB) on target volume coverage and dose to the organs at risk (OAR). 50 breast cancer patients receiving either non-hypofractionated or hypofractionated radiotherapy after lumpectomy including a SIB to the tumor bed were selected for this study. All patients were treated in volumetric modulated arc therapy (VMAT) technique and underwent daily CBCT imaging. In order to estimate the delivered dose during the treatment, the applied fraction doses were recalculated on daily CBCT scans and accumulated using deformable image registration. Based on a total of 2440 dose recalculations, dose coverage in the clinical target volumes (CTV) and OAR was compared depending on the CBCT frequency. The estimated delivered dose (V95%) for breast-CTV and SIB-CTV was significantly lower than the planned dose distribution, irrespective of the CBCT-frequency. Between daily CBCT and CBCT on alternate days, no significant dose differences were found regarding V95% for both, breast-CTV and SIB-CTV. Dose distribution in the OAR was similar for both imaging protocols. Weekly CBCT though led to a significant decrease in dose coverage compared to daily CBCT and a small but significant dose increase in most OAR. Daily CBCT imaging might not be necessary to ensure adequate dose coverage in the target volumes while efficiently sparing the OAR during adjuvant breast cancer radiotherapy with SIB.

摘要

本研究旨在评估辅助乳腺癌放疗中锥形束 CT（CBCT）频率对靶区覆盖和危及器官（OAR）剂量的影响。选择 50 例接受保乳手术后接受非分割或分割放疗（包括肿瘤床 SIB）的乳腺癌患者进行本研究。所有患者均采用容积调强弧形治疗（VMAT）技术进行治疗，并进行每日 CBCT 成像。为了估计治疗过程中的剂量，在每日 CBCT 扫描上重新计算应用的分次剂量，并通过变形图像配准进行累积。基于总共 2440 次剂量重新计算，根据 CBCT 频率比较了临床靶区（CTV）和 OAR 的剂量覆盖情况。无论 CBCT 频率如何，乳房 CTV 和 SIB-CTV 的估计剂量（V95%）都明显低于计划的剂量分布。在每日 CBCT 和隔日 CBCT 之间，乳房 CTV 和 SIB-CTV 的 V95% 没有明显的剂量差异。两种成像方案的 OAR 剂量分布相似。与每日 CBCT 相比，每周 CBCT 导致靶区剂量覆盖显著降低，大多数 OAR 的剂量略有增加。在辅助性乳腺癌放疗中，SIB 每日 CBCT 成像可能没有必要，以确保靶区的足够剂量覆盖，同时有效地保护 OAR。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2d90/8405651/3248308bb65f/41598_2021_96836_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2d90/8405651/5510a758bf9f/41598_2021_96836_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2d90/8405651/3e3bf99fda44/41598_2021_96836_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2d90/8405651/ba034136d488/41598_2021_96836_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2d90/8405651/3248308bb65f/41598_2021_96836_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2d90/8405651/5510a758bf9f/41598_2021_96836_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2d90/8405651/3e3bf99fda44/41598_2021_96836_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2d90/8405651/ba034136d488/41598_2021_96836_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2d90/8405651/3248308bb65f/41598_2021_96836_Fig4_HTML.jpg

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