Parsiyel Meme Işınlamasında Cyberknife Sisteminde Farklı Kolimatörlerle Elde Edilen Stereotaktik Meme Radyoterapisi Sanal Planlarının Karşılaştırılması: Retrospektif Çalışma

Abstract

Çalışmamızda erken evre meme kanseri tanılı hastalarda hızlandırılmış kısmı meme ışınlamasında (HKMI) CyberKnife (CK) tedavi cihazında yapılan sanal planlarda hedef hacim ve kritik organ dozlarının karşılaştırılması amaçlanmıştır. Birimimizde radyoterapi almış 5 hasta için CyberKnife sisteminde Iris, sabit ve çok yapraklı kolimatör (ÇYK) için günlük 6 Gy toplam 30 Gy olacak şekilde sanal plan oluşturuldu. Üç farklı kolimatör için dozimetrik parametreler NSABP-39/RTOG 0413 protokolündeki kısıtlamalara göre analiz edildi. Planlarda kritik organların korunması ve PTV’nin reçete edilen dozun % 95’ini alması sağlandı. Reçete edilen doz minimum % 80’lik izodoz eğrisine tanımlandı. Homojenite indeksi (Hİ), konformite indeksi (Kİ), tedavi süresi (dk), monitör unit (MU) ve kritik organların aldığı dozlar karşılaştırıldı. Iris, sabit kolimatör, ÇYK için sırasıyla Hİ değerleri ortalama 1,2- 1,2- 1,19, Kİ değerleri ortalama 1,08- 1,06- 1,07 tedavi süresi ortalama 47,6- 52,2- 25,4 (dk) ve MU değerleri ortalama 19736,2- 20267,3- 7161,3 olarak bulunmuştur. Planların karşılaştırılması sonucunda MU, tedavi süresi için anlamlı fark bulunmuştur (p< 0,05). Ortalama MU ve tedavi süresi, en düşük ÇYK’da bulunmuştur Hİ, Kİ için anlamlı fark bulunmamıştır. Aynı taraf memenin V30 ve V15 değerleri en düşük ÇYK’da çıkmıştır. Akciğer ve kalp için Dmax değerleri arasında anlamlı bir fark bulunmadı. Sonuç olarak, hedef hacim her kolimatörde istenen dozu almıştır. Karşı meme ve karşı akciğer dozları en düşük Iris’te bulundu. Kalp dozları için sabit kolimatörün daha uygun olduğu bulundu. Fakat bu değerler anlamlı olarak fark yaratmadı. Sabit kolimatörde (52,2 dk), tedavi süresi uzun olduğu için klinik uygulamalarda zorluk çıkarabilir. CyberKnife ile meme SBRT uygulamalarında kolimatör seçimi, tümör boyutu, kritik organlara yakınlık durumu ve tümör lokalizasyonuna bağlı olarak değişebilir.

Keywords

• VMAT
• ÇYK
• CYBERKNIFE
• HKMI

Comparison of Stereotactic Body Radiotherapy Virtual Plans Obtained with Different Colimators in Cyberknife System in Partial Breast Irradiatıon: Retrospective Study

Abstract

In our study, it was aimed to compare the volume of accelerated partial breast irradiation in patients diagnosed with early stage breast cancer in CyberKnife target and volume targeted virtual plans (APBI). A virtual plan was created in CyberKnife system for 5 patients who received radiotherapy in our unit, 6 Gy per day for Iris, fixed and multi-leaf collimator (MLC) and 30 Gy in total. Dosimetric parameters for three different collimators were analyzed according to the constraints of the NSABP-39/RTOG 0413 protocol. In the plans, it was ensured that critical organs were protected and PTV received 95% of the prescribed dose. The prescribed dose was defined by a minimum 80% isodose curve. Homogeneity index (HI), conformity index (CI), treatment time (min), monitor unit (MU) and doses received by critical organs were compared. The mean HI values for iris, fixed collimator, and MLC were 1.2- 1.2- 1.19, mean CI values were 1,08-1,06-1,07, mean treatment time was 47,6- 52,2- 25,4 (min) and MU values were found to be 19736,2-2026,.3- 7161,3 on average. Mean MU and duration of treatment were found in the lowest MLC. No significant difference was found for HI, CI. As a result of the comparison of the plans, a significant difference was found for MU and duration of treatment (p< 0,05).ipsilateral breast30 and V15 were found at the lowest MLC.for lung and heartDmax was no significant difference between. As a result, the target volume received the desired dose in each collimator. The contralateral breast and contra-lateral lung doses were the lowest in Iris. Fixed collimator was found to be more suitable for cardiac doses. But these values did not make a significant difference. In the fixed collimator (52,2 min), it may cause difficulties in clinical applications due to the long treatment time. The choice of collimator in breast SBRT applications with CyberKnife may vary depending on tumor size, proximity to critical organs and tumor localization.

Keywords

• VMAT
• APBI
• MLC
• CYBERKNİFE

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