一个潜在的陷和临床解决方案在表面导向深呼吸呼吸持有辐射治疗左侧乳腺癌的辐射治疗
Chuan Zeng1, Qiyong Fan1, Xiang Li1
1Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
Advances in radiation oncology
|December 4, 2023
概括
在左侧乳腺癌治疗中,腹部驱动的深呼吸呼吸 (A-DIBH) 对于可再生的心脏节省至关重要. 使用表面导向辐射疗法 (SGRT) 识别胸部运动最小的患者 (VCE ≤ 5 mm) 可以确保有效的治疗.
科学领域:
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
- 乳腺癌治疗方法 乳腺癌治疗方法
背景情况:
- 深呼吸喘息 (DIBH) 是心脏剂量减少的关键技术,用于左侧乳腺癌放射治疗.
- 表面导向辐射疗法 (SGRT) 越来越多地用于DIBH设置和运动监测.
- 了解患者特定的呼吸模式,特别是腹部驱动的DIBH (A-DIBH),对于可再生的心脏节省至关重要.
研究的目的:
- 评估腹部驱动DIBH (A-DIBH) 在接受SGRT治疗左侧乳腺癌的患者中的重要性.
- 确定在SGRT工作流程中识别和监测A-DIBH患者的可行性.
- 评估A-DIBH对心脏剂量降低的影响,与自由呼吸 (FB) 条件相比.
主要方法:
- 分析了60名接受SGRT治疗的左侧乳腺癌患者,包括20名前性确诊的A-DIBH患者 (VCE ≤5mm) 和40名对照.
- 计算机断层扫描 (CT) 扫描在自由呼吸 (FB) 和DIBH期间获得,由腹部代孕指导.
- 测量了垂直胸部高度 (VCE) 和腹部运动;在FB和DIBH计划之间比较了心脏和肺部剂量.
主要成果:
- 在A-DIBH患者中,VCE平均为3 ± 2毫米,腹部运动为14 ± 5毫米.
- 与FB相比,在DIBH期间观察到心脏剂量显著减少 (P < .01),平均剂量减少为∆DMax = -8.4 ± 9.8 Gy,∆D5% = -2.4 ± 4.4 Gy和∆DMean = -0.6 ± 0.9 Gy.
- 在对照组中,有15%的患者 (40名患者中有6人) 符合A-DIBH标准 (VCE ≤5毫米).
结论:
- 很大一部分患者 (15%) 呈现A-DIBH特征 (VCE ≤5毫米),需要在SGRT协议中进行特定的识别和监测.
- 建议使用一个感兴趣的腹部区域 (ROI) 或替代体,而不是传统的胸部ROI,以准确监测A-DIBH.
- 保持患者特异性的A-DIBH提高了治疗可重现性,并确保左侧乳腺癌患者的最佳心脏节省.
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