Erken Evre Meme Kanserli Hastalarda Hızlandırılmış Kısmi Meme Işınlamasında VMAT-CyberKnife Sanal Tedavi Planlarının İncelenmesi

Abstract

Erken evre meme kanserli hastalarda hızlandırılmış kısmi meme ışınlamasında Volümetrik Ark Terapi (VMAT) ve CyberKnife teknikleri kullanılarak hedef volüm ile kritik organ dozlarının karşılaştırılması amaçlanmıştır. Bu çalışma için radyoterapi almış 10 erken evre meme kanseri tanılı hasta seçilerek, günlük fraksiyon dozu 6 Gy ve toplam doz 30 Gy olacak şekilde VMAT ve CyberKnife (SBRT) sanal planları oluşturuldu. Homojenite indeksi (HI), konformite indeksi (CI), tedavi süresi (s), görünür hedef volümü (GTV) ve kritik organların aldığı doz değerleri karşılaştırıldı. Tedavi planları arasında GTV’nin Dmax (p=0,002) değeri VMAT tekniği lehine anlamlı fark bulundu. Aynı taraf memenin 30 Gy (V30) (p=0,013) ve 15 Gy alan (V15) volüm değerlerinin (p=0,007) CyberKnife tekniğinde daha az doz aldığı görüldü. Karşı memenin Dmax (p=0,218) değeri açısından anlamlı bir fark bulunmamıştır. Sağ meme yerleşimli olgularda kalbin Dmax (p=0,282) ve 1,5 Gy alan (V1,5) volümü için (p=0,548) anlamlı fark bulunmadı. Sol meme yerleşimli olgularda kalbin Dmax (p=0,095) değerinde anlamlı fark görülmedi; ancak kalbin 1,5 Gy alan (V1,5) volüm değerinin (p=0,008) CyberKnife tekniğinde daha düşük olduğu görüldü. Tedavi süresi (s) (p<0,001) VMAT tekniğinde anlamlı olarak az bulunmuştur. Sonuç olarak iki tedavi tekniğinde de hedef volümün istenilen dozu aldığı; ancak özellikle erken evrede oluşabilecek geç kardiyak yan etkilerin azaltılması açısından riskli hastalarda CyberKnife tekniğinin daha üstün olduğu anlaşılmıştır. Teknolojik gelişmeler ışığında erken evre meme kanserli hastalarda Hızlandırılmış Kısmi Meme Işınlamasında (APBI) güncel tedavi yaklaşımı olarak CyberKnife tekniği uygun olgularda değerlendirilebilir.

Keywords

• APBI
• CyberKnife
• Volümetrik ark terapi
• Erken evre meme kanseri
• SBRT

Investigation of VMAT-Cyberknife Virtual Treatment Plans in Accelerated Partial Breast Irradiation in Patients with Early Stage Breast Cancer

Abstract

It is aimed to compare target volume and critical organ doses by using Volumetric Arc Therapy (VMAT) and CyberKnife techniques in accelerated partial breast irradiation in patients with early stage breast cancer. For this study, 10 patients diagnosed with early stage breast cancer who received radiotherapy were selected. VMAT and CyberKnife (SBRT) virtual plans were created with a daily fraction dose of 6 Gy and a total dose of 30 Gy. Homogeneity index (HI), conformity index (CI), treatment duration (s), gross tumor volume (GTV) and dose values received by critical organs were compared. A significant difference was found between the treatment plans in favor of the VMAT technique in the Dmax (p=0.002) value of GTV. It was observed that 30 Gy (V30) (p=0.013) and 15 Gy (V15) values (p=0.007) of the ipsilateral breast received less dose in CyberKnife technique. There was no significant difference in terms of Dmax (p=0.218) of the contralateral breast. No significant difference was found for Dmax (p=0.282) and volume of the heart receiving 1.5 Gy (V1.5) (p=0.548) in cases located in the right breast. There was no significant difference in heart Dmax (p=0.095) in cases located in the left breast; however, the value (p=0.008) of the heart receiving 1.5 Gy (V1.5) was found to be lower in the CyberKnife technique. The duration (s) of treatment (p<0.001) was found to be significantly less in the VMAT technique. As a result, in both treatment techniques, the target volume received the desired dose; however, it has been found that the CyberKnife technique is superior in risky patients in terms of reducing late cardiac side effects that may occur especially in the early stage. In the light of technological developments, CyberKnife technique can be evaluated in appropriate cases as a current treatment approach in Accelerated Partial Breast Irradiation (APBI) in patients with early stage breast cancer.

Keywords

• APBI
• CyberKnife
• Early stage breast cancer
• SBRT
• Volumetric arc therapy

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