早期左侧乳腺癌的混合规划技术:剂量分配分析和预计的二次癌症相对风险的估计
Iga Racka1, Karolina Majewska1, Janusz Winiecki1,2
1Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Center, Bydgoszcz, Poland.
Acta oncologica (Stockholm, Sweden)
|July 30, 2023
概括
这项研究比较了三种乳腺癌放射治疗技术. 混合VMAT和IMRT提供比3D-CRT更好的目标覆盖和器官节省,但混合VMAT可能会增加二次癌症风险.
科学领域:
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
- 癌症治疗 治疗 癌症治疗
背景情况:
- 三维整形放射治疗 (3D-CRT) 是治疗左侧乳腺癌的标准技术.
- 像混合强度调节放射治疗 (h-IMRT) 和混合体积调节弧线治疗 (h-VMAT) 这样的先进技术旨在改善剂量分配和降低毒性.
- 评估这些技术对于优化治疗结果和患者安全至关重要.
研究的目的:
- 为了比较3D-CRT,h-IMRT和h-VMAT对左侧乳腺癌的剂量有效性.
- 在规划目标体积 (PTV) 和风险器官 (OAR) 中评估剂量分布.
- 为了估计混合技术的二次癌症预计相对风险.
主要方法:
- 40名患有左侧乳腺癌的患者接受了深呼吸呼吸 (DIBH) 的CT模拟.
- 使用3D-CRT,h-IMRT和h-VMAT (h-ARC) 生成治疗计划,其中混合技术结合了3D-CRT和动态场.
- 分析了剂量-体积组图,并使用器官等效剂量 (OED) 概念估计了二次癌症风险.
主要成果:
- 与3D-CRT相比,这两种混合技术都显示出更高的目标覆盖率 (PTV:V95%>98%) 和一致性 (h-ARC:CI=1.18).
- 与3D-CRT和h-ARC相比,h-IMRT显著增加了监视器单位 (MU).
- h-VMAT增加了对侧器官和左肺的剂量 (V5Gy),但显著减少了心脏最大剂量 (Dmax) 5 Gy. 与h-IMRT相比,h-VMAT还显示肺部和右乳腺的二次癌症风险增加.
- 这两种混合技术都显著降低了最大剂量到心脏5Gy.
结论:
- 混合放射治疗技术 (h-IMRT,h-VMAT) 为左侧乳腺癌提供了更好的目标覆盖率和器官节省3D-CRT.
- 虽然h-VMAT使用的监测单位比h-IMRT少,但它可能与预计的二次恶性瘤风险更高有关.
- 这些发现支持使用混合技术,以获得潜在的更好的治疗结果,并仔细考虑二次癌症风险.
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