乳腺癌改良根治术后常规放疗剂量学分析

doi:10.3760/cma.j.issn.1004-4221.2019.09.013

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To investigate the dosimetric characteristics of conventional two-dimensional radiotherapy of the chest wall,supra-and infra-clavicular regions,and the incidental irradiation dosage of the internal mammary region after modified mastectomy in breast cancer patients. Methods Clinical data of 20 breast cancer patients including 10 left and 10 right cases who received radiotherapy after modified mastectomy between 2015 and 2016 were retrospectively analyzed. All patients received irradiation to the chest wall,supra-and infraclavicular regions at a prescription dose of 43.5 Gy in 15 fractions with conventional technique. One anterior-posterior (AP) photon field irradiation was delivered for the supra-and infra-clavicular regions,and one electron field for the chest wall. The supra-and infraclavicular regions were re-planned by using two AP/PA fields and the doses of organ at risk were evaluated. Results With conventional radiotherapy,the D90 of the supra-and infra-clavicular regions were more than 39.15 Gy (EQD2≥45Gy) in 17 patients (85%),and the median D90 of the chest wall was 35.38 Gy. The median dose of incidental internal mammary region was 13.65 Gy. Patients with lower body mass index (BMI) received higher D90 in both supra-and infra-clavicular and chest wall irradiation (P=0.039,0.347). Conclusions Irradiation at D90 of 39.15Gy to the supra-and infra-clavicular regions with AP/PA fields can meet the prescription dose requirement of ≥90% in most cases and does not increase the irradiation dose to normal tissues. The dose distribution of one electron field of the chest wall is poor. Incidental internal mammary region can be irradiated at a limited dosage. BMI is an influencing factor for dose distribution.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Zhai Yirui
	Wang Shulian
	Tang Yu
	Dai Jianrong
	Chen Bo
	Fang Hui
	Ren Hua
	Qi Shunan
	Lu Ningning
	Tang Yuan
	Li Ning
	Liu Yueping
	Song Yongwen
	Yu Zihao
	Jin Jing
	Li Yexiong

Key words： Breast neoplasm/surgery Breast neoplasm/radiotherapy Dosimetry

Received: 15 December 2018

Fund:Key Special Projects for Precision Medical Research of National Research and Development Program (2016YFC0904600)

Corresponding Authors: Wang Shulian,Email:wsl20040118@yahoo.com

Cite this article:

Zhai Yirui,Wang Shulian,Tang Yu et al. Dosimetric evaluation of conventional two-dimensional radiotherapy after modified mastectomy for breast cancer patients[J]. Chinese Journal of Radiation Oncology, 2019, 28(9): 696-700.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2019.09.013 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2019/V28/I9/696

[1] Yu KD,Di GH,Wu J,et al. Development and trends of surgical modalities for breast cancer in China:a review of 16-year data[J]. Ann Surg Oncol,2007,14(9):2502-2509. DOI:10.1245/s10434-007-9436-2.
[2] Offersen BV,Boersma LJ,Kirkove C,et al. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer[J]. Radiother Oncol,2015,114(1):3-10. DOI:10.1016/j.radonc.2014.11.030.
[3] Ebctcg,McGale P,Taylor C,et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality:meta-analysis of individual patient data for 8135 women in 22 randomised trials[J]. Lancet,2014,383(9935):2127-2135. DOI:10.1016/S0140-6736(14)60488-8.
[4] Barsoum M,Mostafa M,El Hossieny H,et al. Dosimetric prospective study comparing 2D and 3D planning for irradiation of supraclavicular and infraclavicular regions in breast cancer patients[J]. J Egypt Natl Canc Inst,2015,27(1):25-34. DOI:10.1016/j.jnci.2014.11.003.
[5] Ma C,Zhang W,Lu J,et al. Dosimetric comparison and evaluation of three radiotherapy techniques for use after modified radical mastectomy for locally advanced left-sided breast cancer[J]. Sci Rep,2015,5:12274. DOI:10.1038/srep12274.
[6] Jing H,Wang SL,Li J,et al. Mapping patterns of ipsilateral supraclavicular nodal metastases in breast cancer:rethinking the clinical target volume for high-risk patients[J]. Int J Radiat Oncol Biol Phys,2015, 93(23):268-276. DOI:10.1016/j.ijrobp.2015.08.022.
[7] Nielsen MH,Berg M,Pedersen AN,et al. Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer:national guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group[J]. Acta Oncol,2013,52(4):703-710. DOI:10.3109/0284186X. 2013.765064.
[8] Madu CN,Quint DJ,Normolle DP,et al. Definition of the supraclavicular and infraclavicular nodes:implications for three-dimensional CT-based conformal radiation therapy[J]. Radiology,2001,221(2):333-339. DOI:10.1148/ radiol.2212010247.
[9] Nielsen HM,Overgaard J,Grau C,et al. Audit of the radiotherapy in the DBCG 82 b&c trials—a validation study of the 1,538 patients randomised to postmastectomy radiotherapy[J]. Radiother Oncol,2005,76(2):285-292. DOI:10.1016/j.radonc.2005.08.002.
[10] Fontanilla HP,Woodward WA,Lindberg ME,et al. Current clinical coverage of Radiation Therapy Oncology Group-defined target volumes for postmastectomy radiation therapy[J]. Pract Radiat Oncol,2012,2(3):201-209. DOI:10.1016/j.prro.2011.10.001.
[11] Rudra S,Al-Hallaq HA,Feng C,et al. Effect of RTOG breast/chest wall guidelines on dose-volume histogram parameters[J]. J Appl Clin Med Phys,2014,15(2):4547. DOI:10.1120/jacmp.v15i2.4547.
[12] Gokula K,Earnest A,Wong LC. Meta-analysis of incidence of early lung toxicity in 3-dimensional conformal irradiation of breast carcinomas[J]. Radiat Oncol,2013,8(2):268. DOI:10.1186/1748-717X-8-268.
[13] Verma V,Vicini F,Tendulkar RD,et al. Role of internal mammary node radiation as a part of modern breast cancer radiation therapy:a systematic review[J]. Int J Radiat Oncol Biol Phys,2016,95(4):617-631. DOI:10.1016/j.ijrobp.2016.01.058.
[14] Hennequin C,Bossard N,Servagi-Vernat S,et al. Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy[J]. Int J Radiat Oncol Biol Phys,2013,86(5):860-866. DOI:10.1016/j.ijrobp.2013.03.021.
[15] Poortmans PM,Collette S,Kirkove C,et al. Internal mammary and medial supraclavicular irradiation in breast cancer[J]. N Engl J Med,2015,373(2):317-327. DOI:10.1056/NEJMoa1415369.
[16] Neuhouser ML,Aragaki AK,Prentice RL,et al. Overweight,obesity,and postmenopausal invasive breast cancer risk:a secondary analysis of the women's health initiative randomized clinical trials[J]. JAMA Oncol, 2015,1(3):611-621. DOI:10.1001/jamaoncol.2015.1546.
[17] Gathirua-Mwangi WG,Zollinger TW,Murage MJ,et al. Adult BMI change and risk of breast cancer:National Health and Nutrition Examination Survey (NHANES) 2005-2010[J]. Breast Cancer,2015,22(7):648-656. DOI:10.1007/s12282-015-0638-3.
[18] Chan DS,Vieira AR,Aune D,et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies[J]. Ann Oncol,2014,25(10):1901-1914. DOI:10.1093/annonc/mdu042.