Sobocka-Kurdyk Urszula, Radomiak Maria, Pawałowski Bartosz, Paluszyńska Marta, Borowska Patrycja, Kowalczyk Dariusz W, Rychter Anna, Skrobała Agnieszka
Department of Medical Physics, Greater Poland Cancer Centre, Poznan, Poland.
Radiotherapy Unit III, Kalisz Branch of the Greater Poland Cancer Centre, Kalisz, Poland.
Rep Pract Oncol Radiother. 2025 Aug 7;30(3):306-315. doi: 10.5603/rpor.105864. eCollection 2025.
To compare doses deposited to the liver during right breast radiotherapy with static and dynamic radiotherapy techniques. The second aim was to introduce the liver load index (LLI), a novel index developed to estimate radiation exposure to the liver prior to treatment selection.
We prepared radiotherapy treatment plans for ten patients with right breast cancer. Plans were created for conventional 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) with and without dose optimisation to liver, and hybrid 3D-CRT/volumetric modulated arc therapy (VMAT). Dosimetric evaluation was based on dose-volume histogram (DVH) parameters. The Wilcoxon test was used to assess differences between treatment plans. Spearman's rank correlation was used to determine the correlation between the LLI and the radiation dose to the liver.
IMRT plans resulted in significantly higher D (p = 0.0051), V (p = 0.0051), and V (p = 0.0051) liver values than 3D-CRT. Compared to non-optimised IMRT [liver not included as an organ at risk (OAR)], liver parameters: V, V, V (p = 0.0051) andV (p = 0.0152) were significantly lower when the IMRT plan was optimised (IMRT), with no increase in doses to other OAR. Compared to standard 3D-CRT, hybrid 3D-CRT/VMAT significantly reduced the V (p = 0.0209), V (p = 0.0077). The LLI was significantly correlated with liver D for 3D-CRT (r = 0.8909, p = 0.0005) and IMRT (r = 0.8303, p = 0.0029), and also with liver D for 3D-CRT (r = 0.8024, p = 0.0052) and IMRT (r = 0.8545, p = 0.0016).
The LLI provides an accurate estimation of liver exposure to radiation during right breast radiotherapy. This index, which is calculated prior to treatment planning, is highly accurate, as evidenced by the strong correlation between the LLI and the mean liver dose.
比较右乳放疗中使用静态和动态放疗技术时肝脏的受量。第二个目的是引入肝脏负荷指数（LLI），这是一种新开发的指数，用于在治疗选择前估计肝脏的辐射暴露情况。
我们为10例右乳癌患者制定了放射治疗计划。计划包括传统的三维适形放疗（3D-CRT）、有和没有对肝脏进行剂量优化的调强放疗（IMRT）以及混合3D-CRT/容积调强弧形放疗（VMAT）。剂量学评估基于剂量体积直方图（DVH）参数。采用Wilcoxon检验评估治疗计划之间的差异。使用Spearman等级相关性分析来确定LLI与肝脏辐射剂量之间的相关性。
与3D-CRT相比，IMRT计划导致肝脏的D（p = 0.0051）、V（p = 0.0051）和V（p = 0.0051）值显著更高。与未优化的IMRT（肝脏未被列为危及器官（OAR））相比，当IMRT计划进行优化（IMRT）时，肝脏参数：V、V、V（p = 0.0051）和V（p = 0.0152）显著降低，且其他OAR的剂量没有增加。与标准3D-CRT相比，混合3D-CRT/VMAT显著降低了V（p = 0.0209）、V（p = 0.0077）。对于3D-CRT（r = 0.8909，p = 0.0005）和IMRT（r = 0.8303，p = 0.0029），LLI与肝脏D显著相关，对于3D-CRT（r = 0.8024，p = 0.0052）和IMRT（r = 0.8545，p = 0.0016），LLI与肝脏D也显著相关。
LLI可准确估计右乳放疗期间肝脏的辐射暴露情况。该指数在治疗计划前计算得出，高度准确，LLI与肝脏平均剂量之间的强相关性证明了这一点。
