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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Cardiac avoidance in breast radiotherapy: a comparison of simple shielding techniques with intensity-modulated radiotherapy.
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Cardiac avoidance in breast radiotherapy: a comparison of simple shielding techniques with intensity-modulated radiotherapy.

机译：乳房放射治疗中的心脏避免：简单屏蔽技术与强度调制放射治疗的比较。

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BACKGROUND AND PURPOSE: Adjuvant breast radiotherapy (RT) is now part of the routine care of patients with early breast cancer. However, analysis of the Early Breast Cancer Trialists' Collaborative suggests that patients with the lowest risk of dying of breast cancer are at significant risk of cardiac mortality due to longer relapse-free survival. Patients with a significant amount of heart in the high-dose volume have been shown to be at risk of fatal cardiac events. This study was designed to assess whether conformal planning or intensity-modulated radiotherapy (IMRT) techniques allow reduced cardiac irradiation whilst maintaining full target coverage. MATERIAL AND METHODS: Ten patients with early breast cancer were available for computed tomography (CT) planning. Each had at least 1 cm maximum heart depth within the posterior border of conventional tangents. For each patient, plans were generated and compared using dose volume histograms for planning target volume (PTV) and organs at risk. The plans included conventional tangents with and without shielding. The shielding was designed to either completely spare the heart or to shield as much heart as possible without compromising PTV coverage. IMRT plans were also prepared using two- and four-field tangential and six-field arc-like beam arrangements. RESULTS: PTV homogeneity was better for the tangential IMRT techniques. For all patients, cardiac irradiation was reduced by the addition of partial cardiac shielding to conventional tangents, without compromise of PTV coverage. The two- and four-field IMRT techniques also reduced heart doses. The average percentage volume of heart receiving >60% of the prescription dose was 4.4% (range 1.0-7.1%) for conventional tangents, 1.5% (0.2-3.9%) for partial shielding, 2.3% (0.5-4.6%) for the two-field IMRT technique and 2.2% (0.4-5.6%) for the four-field IMRT technique. For patients with larger maximum heart depths the four-field IMRT plan achieved greater heart sparing than the partial shielding, although irradiation of the contralateral breast was increased. Full cardiac shielding resulted in the most complete heart sparing but with compromise of the PTV coverage; the mean volume receiving less than 95% of the prescription dose was 4% (range 1.5-8.7%). CONCLUSION: All patients undergoing adjuvant tangential breast RT in whom the heart is seen to be in the high-dose volume should be considered for the addition of cardiac-sparing lead blocks. Three-dimensional CT planning and alternative beam arrangements with IMRT optimization enables more complete cardiac sparing without compromise of PTV coverage in certain patients.
机译：背景与目的：辅助乳腺癌放疗（RT）现在已成为早期乳腺癌患者常规治疗的一部分。但是，对早期乳腺癌研究者协作组织的分析表明，死于乳腺癌的风险最低的患者由于无复发生存期较长，因此具有很高的心脏死亡风险。高剂量的大量心脏患者已显示有致命性心脏事件的风险。这项研究旨在评估保形规划或强度调制放射疗法（IMRT）技术是否可以减少心脏辐射，同时保持完整的靶标覆盖范围。材料与方法：10例早期乳腺癌患者可用于计算机体层摄影（CT）计划。在传统切线的后边界内，每个心脏的最大心脏深度至少为1 cm。对于每位患者，都使用剂量体积直方图生成并比较了计划，以计划目标体积（PTV）和有风险的器官。该计划包括带和不带屏蔽的常规切线。屏蔽的目的是完全保留心脏或尽可能多地屏蔽心脏，而不会影响PTV的覆盖范围。还使用两场和四场切线和六场弧形光束布置来准备IMRT计划。结果：切线IMRT技术的PTV同质性更好。对于所有患者，通过在常规切线处增加部分心脏屏蔽来减少心脏辐射，而不会损害PTV的覆盖范围。两场和四场IMRT技术还减少了心脏剂量。对于常规切线，> 60％处方剂量的心脏的平均体积百分比为4.4％（范围1.0-7.1％），部分屏蔽的平均百分比为1.5％（0.2-3.9％），而对于正切线则为2.3％（0.5-4.6％）两场IMRT技术和四场IMRT技术的2.2％（0.4-5.6％）。对于最大心脏最大深度较大的患者，尽管增加了对侧乳房的照射，但四区域IMRT计划比部分屏蔽实现了更大的心脏保护。完全的心脏屏蔽可最大程度地保留心脏，但会损害PTV的覆盖范围;少于处方剂量的95％的平均体积为4％（范围为1.5-8.7％）。结论：应考虑所有接受辅助切线乳腺放疗的患者，如果心脏处于高剂量，则应考虑增加心脏保护性铅块。具有IMRT优化功能的三维CT计划和替代性束安排可在不损害某些患者的PTV覆盖范围的情况下实现更完整的心脏保留。

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