Abdullah Reduan, Appalanaido Gokula Kumar, Shukor Syadwa Abdul, Zin Hafiz M, Abd Aziz Mohd Zahri, Ishak Norhafizah
Medical Radiation Programme, School of Health Sciences, Universiti Sains Malaysia, Penang, Malaysia.
Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia.
Rep Pract Oncol Radiother. 2021 Dec 30;26(6):892-898. doi: 10.5603/RPOR.a2021.0105. eCollection 2021.
This dosimetric study compared lateral wedge with medial only cardiac shielding (LEMONADE) technique, for left chest wall (LCW) irradiation against three other commonly used techniques.
Dosimetric parameters of 22 consecutive LBC patients treated using the P1 (LEMONADE technique) were compared with 3 other virtually reconstructed plans : no cardiac shielding with paired wedges; P2 (paired wedges and medial only Y-direction shielding) and P3 (paired wedges and bilateral Y-direction shielding).
P1 showed better target volume (TV) coverage with the mean 90% isodose coverage of 85.59% ± 5.44 compared to 78.90% ± 8.59 and 74.22% ± 9.50 for P2 and P3, respectively. Compared to no cardiac shielding, for a 4.65% drop in TV coverage the V26Gy of heart dropped from 6.68% to a negligible 0.85% for P1. TV receiving < 30Gy is also significantly lesser for P1 compared to P2 and P3 (5.42% vs 10.64% and 15.8%), whilst there is a small difference of 2.75% between no cardiac shielding and P1.
With the improvement in BC survival rate, cardiac toxicity associated with adjuvant irradiation for LBC is a major concern. P1 (LEMONADE) technique has a good compromise between cardiac sparing and target coverage and should suffice for most LCW irradiations. Furthermore, the LEMONADE technique is a simple, reproducible and involves fast planning for cardiac sparing, which is ideal for under-resourced departments with heavy workload.
本剂量学研究将左侧胸壁（LCW）放疗的外侧楔形联合仅内侧心脏屏蔽（LEMONADE）技术与其他三种常用技术进行了比较。
将连续22例采用P1（LEMONADE技术）治疗的LBC患者的剂量学参数与其他3个虚拟重建计划进行比较：无心脏屏蔽联合配对楔形板；P2（配对楔形板和仅内侧Y方向屏蔽）和P3（配对楔形板和双侧Y方向屏蔽）。
与P2和P3分别为78.90%±8.59和74.22%±9.50相比，P1的靶区体积（TV）覆盖更好，平均90%等剂量线覆盖为85.59%±5.44。与无心脏屏蔽相比，对于TV覆盖下降4.65%，P1组心脏的V26Gy从6.68%降至可忽略不计的0.85%。与P2和P3相比，P1组接受<30Gy的TV也显著更小（5.42%对10.64%和15.8%），而无心脏屏蔽和P1之间有2.75%的小差异。
随着乳腺癌生存率的提高，与LBC辅助放疗相关的心脏毒性是一个主要问题。P1（LEMONADE）技术在心脏保护和靶区覆盖之间取得了良好的平衡，应该足以满足大多数LCW放疗。此外，LEMONADE技术简单、可重复，且涉及快速的心脏保护计划，这对于工作量大且资源不足的科室来说是理想的。
