National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
Department of Oncology, Yunyang County People's Hospital, Chongqing, 404500, China.
Radiat Oncol. 2022 Mar 28;17(1):60. doi: 10.1186/s13014-022-02009-2.
This study aimed at evaluating the clinical impact of full intensity-modulated radiotherapy (IMRT), hybrid IMRT (H-IMRT) and hybrid volumetric-modulated arc therapy (H-VMAT) for early-stage breast cancer with simultaneous integrated boost (SIB), in terms of plan quality and second cancer risk (SCR).
Three different plans were designed in full IMRT, hybrid IMRT, and hybrid VMAT for each of twenty patients with early-stage breast cancer. Target quality, organs at risk (OARs) sparing, and SCR were compared among the three plans for each case.
In compared with H-IMRT, IMRT plans showed deterioration in terms of D of SIB, V of ipsilateral lung, and excess absolute risk (EAR) to contralateral lung (C-Lung) and esophagus. D and the homogeneity index (HI) of SIB, V5 of ipsilateral lung (I-Lung), the D of the esophagus, the EAR to C-Lung and the esophagus with hybrid VMAT dramatically increased by 0.63%, 10%, 17.99%, 149.27%, 230.41%, and 135.29%, respectively (p = 0.024; 0.025; 0.046; 0.011; 0.000; 0.014). D of the heart, the EAR to contralateral breast (C-Breast) and C-Lung by full IMRT was significantly decreased in comparison to the H-VMAT (4.67%, p = 0.033, 26.76%, p = 0.018; 48.05%, p = 0.036).
The results confirmed that H-IMRT could achieve better target quality and OARs sparing than IMRT and H-VMAT for SIB radiotherapy of early-stage right breast cancer. H-IMRT was the best treatment option, while H-VMAT performed the worst among the three plans in terms of SCR to peripheral OARs.
本研究旨在评估对于行同步推量调强放疗（SIB）的早期乳腺癌患者，全强度调制放疗（IMRT）、混合调强放疗（H-IMRT）和混合容积旋转调强放疗（H-VMAT）在计划质量和第二癌症风险（SCR）方面的临床影响。
为 20 例早期乳腺癌患者的每例患者设计了全 IMRT、混合 IMRT 和混合 VMAT 三种不同的计划。比较了三种计划中每例患者的靶区质量、危及器官（OAR）保护和 SCR。
与 H-IMRT 相比，IMRT 计划在 SIB 的 D、同侧肺的 V 和对侧肺（C-Lung）和食管的超额绝对风险（EAR）方面恶化。同侧肺（I-Lung）的 SIB 的 D 和均匀性指数（HI）、V5、食管的 D、C-Lung 和食管的 EAR 以及混合 VMAT 的 D 显著增加了 0.63%、10%、17.99%、149.27%、230.41%和 135.29%（p=0.024；0.025；0.046；0.011；0.000；0.014）。与 H-VMAT 相比，全 IMRT 时心脏的 D、对侧乳房（C-Breast）和 C-Lung 的 EAR 显著降低（4.67%，p=0.033；26.76%，p=0.018；48.05%，p=0.036）。
结果证实，对于右侧早期乳腺癌的 SIB 放疗，H-IMRT 比 IMRT 和 H-VMAT 能达到更好的靶区质量和 OAR 保护。H-IMRT 是最佳治疗选择，而在 SCR 方面，H-VMAT 在三种计划中对周围 OAR 的影响最差。
