Aldaly Moustafa, Hussien Azza, El-Nadi Inas Mohsen, Laz Nabila Ibrahim, Said Amira S A, Al-Ahmad Mohammad M, Hussein Raghda R S, Rabie Al Shaimaa Ibrahim, Shaaban Ahmed Hassan
Department of Clinical Oncology, Faculty of Medicine, Kasr AL Ainy, Cairo University, Cairo 11956, Egypt.
Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt.
Cancers (Basel). 2023 Dec 11;15(24):5799. doi: 10.3390/cancers15245799.
Multimodality is required for the treatment of breast cancer. Surgery, radiation (RT), and systemic therapy were traditionally used. Pharmacotherapy includes different drug mechanisms, such as chemotherapy, hormone therapy, and targeted therapies, alone or in combination with radiotherapy. While radiation offers numerous benefits, it also has certain harmful risks. such as cardiac and pulmonary toxicity, lymphedema, and secondary cancer. Modern radiation techniques have been developed to reduce organs at risk (OAR) doses.
This study is a prospective feasibility trial conducted at the Fayium Oncology Center on patients with left breast cancer receiving adjuvant locoregional radiotherapy after either breast conservative surgery (BCS) or modified radical mastectomy (MRM). This study aimed to assess the proportion of patients who are fit both physically and intellectually to undergo breast radiotherapy using the deep inspiratory breath-holding (DIBH) technique, comparing different dosimetric outcomes between the 3D dimensional conformal with DIBH and 4D-CT IMRT plans of the same patient.
D95 of the clinical target volume (CTV) of the target is significantly higher in the 3D DIBH plan than in the IMRT plan, with an average of 90.812% vs. 86.944%. The dosimetry of the mean heart dose (MHD) in the 4D-CT IMRT plan was significantly lower than in the 3D conformal with the DIBH plan (2.6224 vs. 4.056 Gy, < 0.0064), and no significant difference between the two plans regarding mean left anterior descending artery (LAD) (14.696 vs. 13.492 Gy, < 0.58), maximum LAD (39.9 vs. 43.5 Gy, < 0.35), and V20 of the ipsilateral lung (18.66% vs. 16.306%, < 0.88) was observed. Internal mammary chain (IMC) irradiation was better in the 4D-CT IMRT plan.
Radiotherapy of the breast and chest wall with the 4D-CT IMRT technique appears not to be inferior to the 3D conformal with the DIBH technique and can be used as an alternative to the 3D conformal with the DIBH technique in patients meeting the exclusion criteria for performing the DIBH maneuver concerning coverage to target volumes or unacceptably high doses to OAR.
乳腺癌的治疗需要多模式治疗。传统上采用手术、放疗（RT）和全身治疗。药物治疗包括不同的药物作用机制，如化疗、激素治疗和靶向治疗，可单独使用或与放疗联合使用。虽然放疗有诸多益处，但也存在某些有害风险，如心脏和肺部毒性、淋巴水肿和继发性癌症。现代放疗技术已得到发展以降低危及器官（OAR）的剂量。
本研究是在法尤姆肿瘤中心对接受保乳手术（BCS）或改良根治性乳房切除术（MRM）后行辅助局部区域放疗的左乳腺癌患者进行的一项前瞻性可行性试验。本研究旨在评估身体和智力上适合采用深吸气屏气（DIBH）技术进行乳房放疗的患者比例，比较同一患者的三维适形联合DIBH计划和四维CT调强放疗（IMRT）计划之间不同的剂量学结果。
靶区临床靶体积（CTV）的D95在三维DIBH计划中显著高于IMRT计划，平均分别为90.812%和86.944%。四维CT IMRT计划中的平均心脏剂量（MHD）剂量学结果显著低于三维适形联合DIBH计划（2.6224对4.056 Gy，<0.0064），且在平均左前降支（LAD）（14.696对13.492 Gy，<0.58）、最大LAD（39.9对43.5 Gy，<0.35）以及同侧肺V20（18.66%对16.306%，<0.88）方面，两个计划之间未观察到显著差异。内乳链（IMC）照射在四维CT IMRT计划中更好。
四维CT IMRT技术用于乳房和胸壁放疗似乎并不逊色于三维适形联合DIBH技术，对于在靶区覆盖或对OAR剂量过高而不符合进行DIBH操作排除标准的患者，可作为三维适形联合DIBH技术的替代方案。
