Purpose:
To analyze the dosimetric and clinical benefit of a forward planned technique to optimize dose distribution in whole-breast irradation (WBI) using additional partial-volume segments (PVSeg).
Patients and Methods:
In two separate treatment periods, 265 breast cancer patients received tangential-field WBI and were retrospectively analyzed. Between 02/2004 and 03/2006, 96 patients were treated with one to two additional low-weighted PVSeg to reduce dose peaks within the target volume. 169 patients treated between 01/2000 and 12/2001 before implementation of this PVSeg technique served as comparison group. Total dose was 50–50.4 Gy (single dose, 1.8–2 Gy). The planning target volume (PTV) receiving at least 95%, 105% and 110% of the reference dose (V95–110%) and frequency of moist skin desquamation during radiotherapy were compared uni- and multivariately with patient- and treatment-related variables.
Results:
The mean PTV was 1,144 ml (range, 235–2,365 ml). Moist skin desquamations developed in 16 patients (17%) with PVSeg compared to 30 patients (18%) without PVSeg (p = 0.482). In breast volumes > 1,100 ml, the corresponding figures were 19% versus 29% (p = 0.133). V105% was significantly reduced by the use of PVSeg (82 ± 51 ml vs. 143 ± 129 ml; p < 0.0001). In univariate analysis, the following variables had significant influence on the development of moist skin desquamation: V95% (p < 0.0001), V105% (p < 0.001), V110% (p = 0.012) adjuvant chemotherapy (p = 0.02), and single dose (p = 0.009). In multivariate analysis, only V95% (p = 0.002) remained significant.
Conclusion:
The use of PVSeg in WBI reduced dose peaks within the PTV while breast volumes > 1,100 ml benefited most. V95% was strongly correlated to the risk of developing moist skin desquamations.
Ziel:
Untersuchung des Nutzens einer einfachen vorwärts geplanten Bestrahlungstechnik mit Partialvolumensegmenten (PVSeg) bei der Ganzbrustbestrahlung.
Patienten und Methodik:
Es wurden 265 Brustkrebspatientinnen aus zwei Behandlungszeiträumen analysiert, die nach brusterhaltender Therapie eine Ganzbrustbestrahlung mit tangentialen Feldern erhielten. Von 02/2004 bis 03/2006 erhielten 96 Patientinnen ein bis zwei zusätzliche, niedriggewichtete PVSeg zur Reduzierung von Dosisspitzen im Zielvolumen. Als Vergleich dienten 169 Patientinnen im Zeitraum von 01/2000 bis 12/2001 vor Einführung der PVSeg-Technik. Die Gesamtdosis betrug 50–50,4 Gy (Einzeldosis: 1,8–2 Gy). Das Planungszielvolumen (PTV), welches mindestens 95%, 105% und 110% der Referenzdosis (V95–110%) erhielt, und die Häufigkeit feuchter Epitheliolysen während der Bestrahlung wurden mittels uni- und multivariater Analyse mit Patienten- und Behandlungsparametern verglichen.
Ergebnisse:
Das mittlere PTV betrug 1 144 ml (Streubreite: 235–2 365 ml). Feuchte Epitheliolysen traten bei 16 Patientinnen (17%) mit PVSeg versus 30 Patientinnen (18%) ohne PVSeg auf (p = 0,482). Bei Brustvolumina > 1 100 ml wurden feuchte Epitheliolysen mit und ohne PVSeg bei 19% versus 29% beobachtet (p = 0,133). Mit der PVSeg-Technik wurde V105% signifikant gesenkt (82 ± 51 ml vs. 143 ± 129 ml; p < 0,0001). In der univariaten Analyse beeinflussten folgende Faktoren die Entwicklung feuchter Epitheliolysen signifikant: V95 (p < 0,0001), V105% (p < 0,001), V110% (p = 0,012), eine adjuvante Chemotherapie (p = 0,02) und die Höhe der Einzeldosis (p = 0,009). In der multivariaten Analyse blieb nur V95% (p = 0,002) signifikant.
Schlussfolgerung:
Die vorgestellte PVSeg-Technik reduzierte Dosisspitzen im PTV, wobei Patientinnen mit Brustvolumina > 1 100 ml am meisten profitierten. Es konnte eine starke Korrelation zwischen V95% und dem Auftreten feuchter Epitheliolysen gefunden werden.
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Tromm, E., Meyer, A., Frühauf, J. et al. Partial-Volume Segmentation for Dose Optimization in Whole-Breast Radiotherapy. Strahlenther Onkol 186, 40–45 (2010). https://doi.org/10.1007/s00066-009-2031-7
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DOI: https://doi.org/10.1007/s00066-009-2031-7
Key Words:
- Breast cancer
- Whole-breast radiotherapy
- Partial-volume segmentation
- Dose optimization
- Moist skin desquamation