DBCG IMN2研究中内乳淋巴结照射的质量保证
Quality assurance of internal mammary node irradiation in the DBCG IMN2 study.
作者信息
Refsgaard Lasse, Buhl Emma S, Nielsen Anders W Mølby, Thomsen Mette S, Andersen Karen, Jensen Ingelise, Berg Martin, Lorenzen Ebbe L, Thorsen Lise B J, Overgaard Jens, Korreman Stine S, Offersen Birgitte V
机构信息
Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
出版信息
Radiother Oncol. 2025 Jan;202:110600. doi: 10.1016/j.radonc.2024.110600. Epub 2024 Nov 8.
PURPOSE/OBJECTIVE: The Danish Breast Cancer Group (DBCG) IMN2 study investigated the gain from internal mammary node irradiation (IMNI) in node-positive breast cancer patients. IMNI was indicated in right-sided patients, but not in left-sided. Target volume delineations were based on bony landmarks in contrast to the contemporary vessel-based ESTRO consensus guideline. Our objective was to compare IMNI doses in right-sided versus left-sided patients.
MATERIAL/METHODS: Treatment plans and delineated structures including CTVn_IMN (IMN_old) from 2008 to 2014 were collected from the DBCG RT Nation study. During the study period, IMN_old was only delineated in right-sided patients. Right and left-sided CTVn_IMN structures were auto-segmented following the ESTRO guidelines (IMN_ESTRO). Due to cranial discordance between IMN_old and IMN_ESTRO, the IMN_ESTRO models were separated into IMN_ESTRO_cranial and IMN_ESTRO_intercostal space(IC)1-3, IC1-4, and IC4_only.
RESULTS
Treatment plans for 2837 patients were available (62.5 % of patients in the IMN2 study). In right-sided patients, the median IMN_old dose coverage (92.4 %) was higher than IMN_ESTRO (71.7 %), p < 0.001. Dose coverage in IMN_ESTRO_IC1-3 was comparable to IMN_old. Comparing IMN_ESTRO_IC1-3 in all patients by laterality, the median CTVn_V90% was 94.6 % (IQR 64.8-100.0) in right-sided patients and 20.4 % (IQR 0.9-55.8) in left-sided patients, p < 0.001. For right-sided patients, median CTV_V90% was 82.3 % in IMN_ESTRO_IC4_only. Median mean heart doses were lower in right-sided patients (1.2 Gy) than in left-sided (2.3 Gy), p < 0.001. Median mean lung doses were higher in right-sided patients (16.0 Gy) than in left-sided (12.7 Gy), p < 0.001.
CONCLUSION
For IMN_ESTRO_IC1-3, we found a significantly higher IMN dose coverage in right-sided than in left-sided patients supporting treatment according to study guidelines in the DBCG IMN2 study.
目的/目标：丹麦乳腺癌研究组（DBCG）的IMN2研究探讨了内乳淋巴结照射（IMNI）对淋巴结阳性乳腺癌患者的益处。右侧患者需进行IMNI，左侧患者则无需。与当代基于血管的欧洲放射肿瘤学会（ESTRO）共识指南不同，靶区勾画基于骨性标志。我们的目的是比较右侧与左侧患者的IMNI剂量。
材料/方法：从DBCG RT Nation研究中收集了2008年至2014年的治疗计划及勾画结构，包括CTVn_IMN（IMN_old）。在研究期间，仅对右侧患者勾画了IMN_old。按照ESTRO指南（IMN_ESTRO）对右侧和左侧的CTVn_IMN结构进行自动分割。由于IMN_old与IMN_ESTRO在头侧存在不一致，将IMN_ESTRO模型分为IMN_ESTRO_头侧和IMN_ESTRO_肋间间隙（IC）1 - 3、IC1 - 4以及仅IC4。
结果
有2837例患者的治疗计划可用（占IMN2研究患者的62.5%）。在右侧患者中，IMN_old的中位剂量覆盖（92.4%）高于IMN_ESTRO（71.7%），p < 0.001。IMN_ESTRO_IC1 - 3的剂量覆盖与IMN_old相当。按左右侧比较所有患者的IMN_ESTRO_IC1 - 3，右侧患者CTVn_V90%的中位数为94.6%（四分位间距64.8 - 100.0），左侧患者为20.4%（四分位间距0.9 - 55.8），p < 0.001。对于右侧患者，仅IMN_ESTRO_IC4中CTV_V90%的中位数为82.3%。右侧患者的中位平均心脏剂量（1.2 Gy）低于左侧（2.3 Gy），p < 0.001。右侧患者的中位平均肺剂量（16.0 Gy）高于左侧（12.7 Gy），p < 0.001。
结论
对于IMN_ESTRO_IC1 - 3，我们发现右侧患者的IMN剂量覆盖显著高于左侧患者，支持DBCG IMN2研究中根据研究指南进行治疗。
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