Kószó Renáta L, Kahán Zsuzsanna, Darázs Barbara, Rárosi Ferenc, Varga Zoltán
Department of Oncotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.
Department of Medical Informatics, Faculty of Medicine, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary.
Rep Pract Oncol Radiother. 2021 Dec 30;26(6):990-1002. doi: 10.5603/RPOR.a2021.0123. eCollection 2021.
The aim of the study was to individualize accelerated partial breast irradiation based on optimal dose distribution, protect risk organ and predict most advantageous technique.
138 breast cancer patients receiving postoperative APBI were enrolled. APBI plans were generated using 3D-conformal (3D-CRT), sliding window intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT). In the case of superficial tumours, additional plans were developed by adding electron beam. To planning target volume (PTV) 37.5 Gy/10 fractions, 1 fraction/day was prescribed. A novel plan quality index (PQI) served as the basis for comparisons.
IMRT was the most advantageous technique regarding homogeneity. VMAT provided best conformity, 3D-CR T - the lowest lung and heart exposure. PQI was the best in 45 (32.61%) VMAT, 13 (9.42%) IMRT, 9 (6.52%) 3D-CRT plans. In 71 cases (51.45%) no difference was detected. In patients with large PTV, 3D-CRT was the most favourable. Additional electron beam improved PQI of 3D-CRT plans but had no meaningful effect on IMRT or VMAT. IMRT was superior to VMAT if the tumour was superficial (p < 0.001), situated in the medial (p = 0.032) or upper quadrant (p = 0.046).
In half of all cases, individually selected teletherapy techniques provide superior results over others; relevance of a certain technique may be predicted by volume and PTV localization.
本研究的目的是基于最佳剂量分布实现加速部分乳腺照射个体化，保护危及器官并预测最有利的技术。
纳入138例接受术后加速部分乳腺照射的乳腺癌患者。使用三维适形放疗（3D-CRT）、滑动窗口调强放疗（IMRT）和容积调强弧形放疗（VMAT）生成加速部分乳腺照射计划。对于浅表肿瘤，通过添加电子束制定额外的计划。向计划靶体积（PTV）处方37.5 Gy/10次分割，每天1次分割。一种新的计划质量指数（PQI）作为比较的基础。
IMRT在均匀性方面是最有利的技术。VMAT提供了最佳的适形性，3D-CRT使肺和心脏受照剂量最低。PQI在45例（32.61%）VMAT、13例（9.42%）IMRT、9例（6.52%）3D-CRT计划中最佳。71例（51.45%）未检测到差异。在PTV较大的患者中，3D-CRT是最有利的。额外的电子束改善了3D-CRT计划的PQI，但对IMRT或VMAT没有显著影响。如果肿瘤位于浅表（p<0.001）、内侧（p=0.032）或上象限（p=0.046），IMRT优于VMAT。
在所有病例的一半中，个体化选择的远距离治疗技术比其他技术提供更好的结果；特定技术的相关性可通过体积和PTV定位来预测。
