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保乳术后腋窝淋巴结标准切线野与多野放疗的剂量学比较
彭冉，王淑莲，任雯婷，王维虎，房辉，宋永文，刘跃平，张可，苗俊杰，李晔雄，
100021 北京协和医学院 中国医学科学院肿瘤医院放疗科
Standard whole breast tangential fields provide suboptimal axillary coverage and whole axilla radiation significantly increase lung dose in Chinese breast cancer patients treated with breast conservative surgery and sentinel node biopsy
Peng Ran, Wang Shulian, Ren Wenting, Wang Weihu, Fang Hui, Song Yongwen, Liu yueping, Zhang Ke, Miao Junjie, Li yexiong
Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College,Beijing 100021, China
Abstract：Objective This study aimed to evaluate the coverage of the Level I and Ⅱ axilla with standard whole breast tangential fields (WBTF), and to what extent that whole axilla radiation could increase the dose to normal tissue with dosimetric study. Methods Fifteen consecutive left breast cancer patients treated with breast conservative surgery and sentinel node biopsy followed by whole breast radiation were studied. All had inverse IMRT plan using WBTF with prescription dose of 50 Gy to 95% of the planning target volume (PTV), defined as the whole breast. Level I and Ⅱ axilla was contoured according to the RTOG atlas. The dose distribution and coverage of Level I and Ⅱ axilla with WBTF was calculated. New plans delivering 50 Gy to 95% of the whole breast as well as Level I and Ⅱ axilla (WB+AX) were designed. The homogeneity index (HI=D5/D95) of the whole breast and conformal index (CI=VRI/TV, TV=target volume, VRI=Volume of the Reference Isodose) of the two plan, the dose to the heart, lung, left anterior descending coronary artery (LAD) and contralateral breast were compared between WBTF and WB+AX. Results The volume of Levels I and Ⅱ axilla was 71.7 and 26.5 cm2, respectively. With WBTF, the average dose to Levels I and Ⅱ axilla was 34.39 Gy and 21.90 Gy, respectively. The V50 and V40 were 22.57% and 49.86% for Level I axilla, 5.99% and 21.99% for Level Ⅱ axilla. WB+AX significantly increased the HI of the whole breast, and CI of the two plans and also significantly increased the dose to the ipsilateral lung and heart as compared with WBTF. There was no significant difference in mean dose to LAD between WBTF and WB+AX. Conclusions Standard whole breast tangential field doesn′t offer optimal coverage of Level I and Ⅱ axilla. Patients who had high-risk relapse of axilla should be planned to adequately cover the whole axilla if axilla dissection is not performed. Given the compromised dose homogeneity of the whole breast and the significantly increased lung dose with WB+AX plan, axilla dissection and axilla radiation should be weighted and discussed with patients for those who need axilla treatment.
Peng Ran,Wang Shulian,Ren Wenting et al. Standard whole breast tangential fields provide suboptimal axillary coverage and whole axilla radiation significantly increase lung dose in Chinese breast cancer patients treated with breast conservative surgery and sentinel node biopsy[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 154-158.
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2015, Vol. 24 
