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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Cardiac and pulmonary doses and complication probabilities in standard and conformal tangential irradiation in conservative management of breast cancer.
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Cardiac and pulmonary doses and complication probabilities in standard and conformal tangential irradiation in conservative management of breast cancer.

机译：在保守治疗乳腺癌中，标准和保形切线照射中的心脏和肺部剂量以及并发症的可能性。

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Background and purpose: The clinical benefit of irradiating the intact breast after lumpectomy must be weighted against the risk of severe toxicity. We present a study on cardiac and pulmonary dose-volume data and the related complication probabilities of tangential breast irradiation having the following objectives: (1) to quantify the sparing of the organs at risk (ORs), the heart and the lung, achieved by three-dimensional (3-D) conformal tangential irradiation (CTI) as compared to standard tangential irradiation (STI); (2) to elucidate the uncertainty in radiation tolerance data; and (3) to analyse the relation between the amount of OR irradiated and the resulting morbidity risk.Material and methods: Computed tomography (CT)-based 3-D treatment plans of 26 patients prescribed to CTI of the intact breast were applied. Contour-based STI has been our routine treatment, and was reconstructed for all patients. Dose-volume data and normal tissue complication probability (NTCP) predictions from the probit and relative seriality models with several cardiac and pulmonary tolerance parameterizations were analysed and compared.Results and conclusions: A significant amount of normal tissues can be spared from radiation by using CT-based CTI, resulting in a 50% reduction of the average excess cardiac mortality risk in the left-sided cases. The risks for pericarditis and pneumonitis were too low to reveal any clinically significant difference between the treatments. For the STI set-up, a regression analysis showed that the excess cardiac mortality risk increased when larger parts of the heart were inside the fields. However, the different excess cardiac mortality and pneumonitis tolerance parameters resulted in statistically significant different NTCPs, which precluded the ability to accurately predict absolute NTCPs after tangential breast irradiation. Despite this uncertainty the different series of cardiac and pulmonary risk predictions were in relatively good agreement when small volumes of the ORs were irradiated. From the present data and without consideration of patient or organ motion, it therefore appears that tangential breast irradiation with less than 1 cm of the heart and 2-2.5 cm of the lung included inside the treatment fields will cause at most 1 per thousand risk for cardiac mortality and pulmonary morbidity. CT-based CTI should be considered, in particular for the left-sided cases, if these requirements cannot be met.
机译：背景与目的：必须权衡乳房切除术后照射完整乳房的临床益处与严重毒性的风险。我们目前对心脏和肺部剂量数据以及切线乳房照射相关并发症的可能性进行研究，其目标如下：（1）量化通过以下方法实现的危险器官（OR），心脏和肺的备用与标准切线辐射（STI）相比，三维（3-D）保形切线辐射（CTI）; （2）阐明辐射耐受性数据的不确定性;材料和方法：应用基于计算机断层扫描（CT）的3-D治疗方案，对26例接受完整乳腺CTI治疗的患者进行了基于CT的3-D治疗计划。基于轮廓的性传播感染已成为我们的常规治疗方法，并已为所有患者重建。分析并比较了通过概率和相对序列模型以及几种心脏和肺部耐受性参数设置的剂量量数据和正常组织并发症概率（NTCP）预测。结果和结论：使用CT可以使大量正常组织免于辐射的CTI，可将左侧病例的平均平均心脏额外死亡风险降低50％。心包炎和肺炎的风险太低，以至于无法揭示两种治疗之间的任何临床上的显着差异。对于STI设置，回归分析表明，当心脏的较大部分位于视野内时，额外的心脏死亡风险增加。但是，不同的过高心脏死亡率和肺炎耐受性参数导致统计学上显着不同的NTCP，这使得切线乳房照射后无法准确预测绝对NTCP的能力。尽管存在这种不确定性，但是当对少量的OR进行辐照时，不同系列的心脏和肺部危险性预测相对一致。从目前的数据来看，在不考虑患者或器官运动的情况下，治疗区域内包括不到1 cm的心脏和少于2-2.5 cm的肺部的切向乳房放射线将最多导致千分之一的患儿。心脏死亡率和肺部发病率。如果不能满足这些要求，则应考虑基于CT的CTI，特别是对于左侧病例。

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