Herbolsheimer M, Baier K, Götz-Gersitz U, Güllenstern M L, Jocher R, Rotte D, Sauer O
Röntgen- und Strahlenabteilung, Universitäts-Frauenklinik Würzburg.
Strahlenther Onkol. 1994 Feb;170(2):85-90.
The paper describes the clinical aspects of postoperative irradiation of breast cancer using electron arc technique at the chest wall. The value of the treatment is assessed by long-term results concerning the rate of local recurrences and side effects. The advantages of the procedure are described with regard to physical and technical aspects.
After mastectomy, 117 patients underwent and adjuvant radiotherapy of the chest wall by multisegmental electron rotation technique with energies between 4 and 14 MeV. The number and angular range of the segments as well as the energy of the electrons depended on the peculiar thickness of the chest wall. 25 times 2 Gy were applied within five weeks. The treatment planning is based on a patient model constructed from five CT-slices at least.
In four cases (3.4%) a local relapse and in one case (0.9%) a relapse in supraclavicular lymphatics was found. The recurrences appeared after an average period of 32 months. The mean observation time was 70 months. In 37 women (32%) distant metastases were seen after 29 months on an average. The five-year survival rate is 73.5%.
In comparison to usual techniques using photons the described method shows a more homogeneous dose distribution to the chest wall and a reduction of lung radiation exposure. The clinical result of this dose adaptation to the treatment volume is a lower rate of local relapses and of side effects, inclusive late reactions. It can be suggested that the efficiency of the procedure will be ameliorated in future using special electron compensators. This will result in a more favorable adaptation of dose distribution to the anatomical situation in regard to the cranio-caudal profile.
本文描述了采用电子弧形技术对乳腺癌胸壁进行术后放疗的临床情况。通过局部复发率和副作用的长期结果评估该治疗方法的价值。从物理和技术方面描述了该方法的优势。
117例患者在乳房切除术后，采用能量为4至14 MeV的多野电子旋转技术对胸壁进行辅助放疗。野的数量、角度范围以及电子能量取决于胸壁的具体厚度。在五周内给予25次，每次2 Gy的照射。治疗计划至少基于由五张CT切片构建的患者模型。
发现4例（3.4%）出现局部复发，1例（0.9%）出现锁骨上淋巴结复发。复发平均出现在32个月后。平均观察时间为70个月。37名女性（32%）平均在29个月后出现远处转移。五年生存率为73.5%。
与使用光子的常规技术相比，所述方法显示出胸壁剂量分布更均匀，肺部辐射暴露减少。这种剂量适应治疗体积的临床结果是局部复发率和副作用（包括晚期反应）较低。可以认为，未来使用特殊的电子补偿器将提高该方法的效率。这将导致剂量分布在头脚方向上更有利于适应解剖情况。
