Simultaneous Bilateral Chest Wall Irradiation, Can Helical Tomotherapy Improve Dose Distribution?

A. Elashwah, A. Mousa, Ghadeer Nazer
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Abstract

Background: Radiotherapy to bilateral breast cancer (BBC) is technically challenging because of the proximity to organs as the heart and lungs. Aim: We conducted this study tocompare helical tomotherapy (HT) to 3-dimensional conformal radiation therapy (3D-CRT) technique in bilateral chest wall irradiation regarding the coverage of target volume and the doses recorded at adjacent organs at risk. Methods: Ten patients with synchronous BBC who underwent bilateral mastectomy were included. Two plans were performed for each patient using HT and 3D-CRT. Results: Target volume included bilateral chest wall, bilateral supraclavicular and level III axillary lymph nodes. Prescription dose was 50 Gy/25 fractions in 5 weeks. The mean chest wall planning target volume (PTV) homogeneity index and conformality index were 0.15 and 1.09 in HT versus 0.37 and 1.43 in 3D-CRT plans (p= 0.012 and 0.031). At least 95% of the prescribed dose was covering 96% and 92% of the chest wall PTV for HT and 3D-CRT plans (p= 0.026). Helical tomotherapy plans achieved significant decrease in all cardiac parameters compared to 3D-CRT plans. Helical tomotherapy also achieved reduction in mean dose and V20 for both lungs in expense of higher low dose to normal healthy tissue and longer treatment time in comparison to 3D-CRT.  Conclusion: For BBC patients treated with bilateral chest wall and supraclavicular lymph nodes irradiation, HT provides more conformal and homogenous plan than conventional 3D-CRT plans. Helical tomotherapy improves chest wall PTV coverage and decreases the dose to the heart and lungs in expense of more volume of normal tissues exposure to low doses of radiation and longer treatment time.
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同时双侧胸壁照射,螺旋断层治疗能改善剂量分布吗?
背景:双侧癌症(BBC)的放射治疗在技术上具有挑战性,因为它靠近心脏和肺部等器官。目的:我们进行了这项研究,比较了螺旋断层治疗(HT)和三维适形放射治疗(3D-CRT)技术在双侧胸壁照射中的目标体积覆盖率和在邻近危险器官记录的剂量。方法:对10例同期接受双侧乳房切除术的乳腺癌患者进行回顾性分析。使用HT和3D-CRT为每位患者执行两个计划。结果:靶体积包括双侧胸壁、双侧锁骨上和III级腋窝淋巴结。处方剂量为5周50Gy/25次。HT的平均胸壁规划目标体积(PTV)均匀性指数和一致性指数分别为0.15和1.09,而3D-CRT计划为0.37和1.43(p=0.012和0.031)。HT和3D-CRT方案中,至少95%的处方剂量覆盖了96%和92%的胸壁PTV(p=0.026)。与3D-CRT相比,螺旋断层治疗方案的所有心脏参数均显著降低计划。与3D-CRT相比,螺旋断层治疗还降低了两肺的平均剂量和V20,以牺牲对正常健康组织更高的低剂量和更长的治疗时间为代价。结论:对于接受双侧胸壁和锁骨上淋巴结放疗的BBC患者,HT比传统的3D-CRT方案提供了更一致、更均匀的方案。螺旋断层治疗提高了胸壁PTV的覆盖率,并减少了对心脏和肺部的剂量,以牺牲更多体积的正常组织暴露于低剂量辐射和更长的治疗时间。
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审稿时长
8 weeks
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