Meme Koruyucu Cerrahi Sonrası (MKC) Simultane İntegre Boost (SIB) Tekniğinin Farklılığı

Öz

Meme koruyucu cerrahi (MKC) sonrası tüm meme ışınlaması erken evre meme kanseri için standart tedavidir. Erken evre meme kanseri için meme koruyucu cerrahi ve ardından postoperatif radyoterapi mastektomi kadar etkilidir. Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Radyasyon Onkoloji kliniğine başvurmuş erken evre 10 meme kanserli hasta çalışmaya dahil edilmiştir. Çalışma retrospektif bir çalışma olup, hastalar çalışmalarda geçen plan ve tekniklerle tedavi edilmemiştir. Yapılan çalışmada meme kanseri nedeniyle meme koruyucu cerrahi uygulanmış hastalarda tüm meme ve boost alanına Sekansiyel Yoğunluk Ayarlı Radyoterapi (YART) ve Simultane İntegre ek (Boost) Yoğunluk Ayarlı Radyoterapi (SIB YART) teknikleri ile planlanan hedef alanı (PTV) ve risk altındaki organların (OAR) dozimetrik olarak karşılaştırılması amaçlanmaktadır. Çalışma için ardışık YART kullanılan hastalara tüm memeye 50 Gy/25 fraksiyon ve boost alanına 10 Gy/ 5 fraksiyon, SIB YART kullanılan hastalara da tüm memeye toplam 50,4 Gy/ 28 fraksiyon verilirken aynı zamanda boost hacmine ek doz 60 Gy/ 28 fraksiyon doz verilir. Aynı taraf akciğer, kalp, PTV meme ve PTV boost alanlarının minimum ve maksimum dozları ile Homojenite indeks (HI), konformite indeks (CI) değerleri eşleşmiş veriler için t – testi minitab programı yardımı ile alınan sonuçlar istatistiksel olarak değerlendirilmiştir.
SIB YART tekniği ile Ardışık YART tekniği aynı taraf akciğer; V5 değerinin 10 hasta için ortalama dozları karşılaştırıldığında sonuçlar istatistiksel olarak anlamlı değilken, V20 değeri 10 hasta için ortalama doz değeleri karşılaştırıldığında istatiksel olarak anlamlı olup SIB YART tekniği ile aynı taraf akciğer V20’de daha düşük doz ile tedavi gerçekleştirilebileceği ortaya konulmuştur. Kalp ortalama ve kalp V20 değerleri iki teknik için karşılaştırıldığında SIB YART tekniği istatistiksel olarak anlamlı bulunmamış olup, Ardışık YART tekniğine göre herhangi bir üstünlüğü yoktur. Tüm memede doz homojenitesi SIB YART ile daha iyi iken boost alanı homojenitesi ve tüm meme konformite indeksinde fark izlenmedi. Işınlanan fazla normal doku hacimlerini azaltmak, tedavi sürecini kısaltmak, risk altındaki organlarda doz azaltımı, meme için fraksiyon başına düşen dozu azaltmak ve akut cilt toksititesi insidansının düşük olması nedeniyle boost alanına fraksiyon başına dozu arttırmak için SIB YART tekniği, meme koruyucu RT'de standart kullanım için önerilebilinir.

Anahtar Kelimeler

• Meme Kanseri,Simultane İntegre Boost,Yoğunluk Ayarlı Radyotaerapi (YART),Meme Koruyucu Cerrahi

Difference of Simultaneous Integrated Boost Technique after Breast Conserving Surgery

Abstract

Whole breast irradiation after breast conserving surgery (BCS) is the standard treatment for early stage breast cancer. For early-stage breast cancer, breast-conserving surgery and subsequent postoperative radiotherapy are as effective as mastectomy. An early stage 10 breast cancer patient admitted to the Radiation Oncology Clinic of Sisli Hamidiye Etfal Training and Research Hospital was included in the study. The study is a retrospective study and patients were not treated with the plans and techniques used in the studies. In the study, the planning target volume (PTV) and the organs at risk (OAR) planned with Sequential Intensity Modulated Radiotherapy (IMRT) and Simultaneous Integrated Supplement (Boost) Intensity Modulated Radiotherapy (SIB IMRT) techniques in patients who have undergone breast conserving surgery due to breast cancer. It is aimed to be compared dosimetrically. For the study, patients with consecutive IMRT were given 50 Gy / 25 fraction to the whole breast and 10 Gy / 5 fraction to the boost area, while patients with SIB IMRT were given a total of 50.4 Gy / 28 fractions to the entire breast, while additional dose to the boost volume was given 60 Gy / 28 fraction dose. Ipsilateral lung, heart, the minimum and maximum doses of the PTV breast and PTV boost areas and the homogeneity index (HI), conformity index (CI) values were matched with the help of the t - test minitab program.

SIB IMRT technique and Sequential IMRT technique the ipsilateral lung; When the average doses of V5 value for 10 patients are compared, the results are not statistically significant, while the V20 value is statistically significant when the average dose values for 10 patients are compared, it has been demonstrated that SIB IMRT technique can be performed with a lower dose in the ipsilateral lung V20. When the heart average and heart V20 values are compared for the two techniques, the SIB IMRT technique was not statistically significant, and it has no superiority over the Sequential IMRT technique. While dose homogeneity was better with SIB IMRT in whole breasts, there was no difference in boost area homogeneity and whole breast conformity index SIB IMRT technique for decreasing excess normal tissue volumes irradiated, shortening the treatment process, dose reduction in organs at risk, reducing the dose per fraction for the breast and increasing the dose per fraction to the boost area due to the low incidence of acute skin toxicity, standard use in breast protector RT it can be recommended for.

Keywords

• Breast cancer,Simultaneous integrated boost,Intensity modulated radiotherapy (IMRT),Breast conserving surgery

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