DOSIMETRIC ANALYSIS OF DEEP INSPIRATION BREATH HOLD TECHNIQUE ADAPTED TO TANGENTIAL-BASED VOLUMETRIC MODULATED ARC THERAPY FOR LEFT BREAST CANCER AFTER MASTECTOMY

Öz

Purpose: To evaluate the dosimetric properties of the deep inspiration breath hold (DIBH) technique adapted to tangential-based volumetric modulated arc therapy (TVMAT) in left breast cancer patients with mastectomy. Method: Forty-three patients who underwent mastectomy and received chest wall and regional lymph node irradiation were included in the study. Simulation computed tomography (CT) was performed in DIBH and free-breathing (FB). Two plans were created for each patient; DIBH-TVMAT and FB-TVMAT. Both plans were realized using a mono-isocentric technique with two partial arc rotations, and the same gantry angles were used.The standard fractionation schedule for each patient was set to 50 Gy in 25 fractions. Paired-sample T-test was used to evaluate the dosimetric parameters. Results: The comparison between FB-TVMAT and DIBH-TVMAT plans revealed mean heart doses of 8.9 Gy and 5.4 Gy, respectively (p=0.000). A 6.2% reduction was encountered in left lung volume receiving 5 Gy (V5) in the DIBH-TVMAT plan (p=0.01). A reduction of 1.3 Gy at a percentage of 28% was monitored in the mean dose of the right lung in DIBH-TVMAT (p=0.000). The mean right breast dose was 0.7 Gy lower in DIBH-TVMAT (p=0.000). Conclusion: The results support that the adaptation of DIBH to TVMAT allows an optimal target volume dose coverage as well as leads to significant dose reductions in the left lung, right lung, heart, LADCA, and right breast for the left breast cancer patients with mastectomy.

Anahtar Kelimeler

• Breast cancer
• Tangential volumetric modulated arc therapy
• Deep inspiration breath hold
• Radiotherapy
• Mastectomy

Destekleyen Kurum

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Proje Numarası

2020/32

Etik Beyan

Ethical Statement All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed Consent The informed consent form was obtained from all subjects. Our study was approved by the independent ethics committee/institutional review board at Erciyes University Medical Faculty Ethical Committee. The first ethics committee approval was obtained prior to the initiation of the study, with the approval number 2020/32 and the date 15.01.2020. The second ethics committee approval was granted under the approval number 2024/175 on 13.03.2024.

Teşekkür

None

MASTEKTOMİ SONRASI SOL MEME KANSERİNDE TANJANSİYEL TEMELLİ HACİMSEL MODÜLELİ ARK TERAPİSİNE UYARLANAN DERİN İNHALASYONDA NEFES TUTMA TEKNİĞİNİN DOZİMETRİK ANALİZİ

Öz

Amaç: Bu çalışmada, mastektomi uygulanmış sol meme kanseri hastalarında, tanjansiyel temelli hacimsel modüleli ark terapisine (TVMAT) entegre edilen derin inhalasyonda nefes tutma (DIBH) tekniğinin dozimetrik özelliklerinin değerlendirilmesi amaçlanmıştır. Yöntem: Çalışmaya mastektomi geçirmiş ve torakal duvar ile bölgesel lenf nodlarına radyoterapi uygulanan 43 hasta dâhil edilmiştir. Simülasyon bilgisayarlı tomografileri (BT), hem DIBH hem de serbest solunum (FB) modlarında alınmıştır. Her hasta için DIBH-TVMAT ve FB-TVMAT olmak üzere iki ayrı tedavi planı oluşturulmuştur. Her iki plan da mono-izosentrik teknikle ve iki parsiyel ark rotasyonu kullanılarak, aynı gantri açılarıyla planlanmıştır. Tüm hastalar için fraksiyonasyon şeması 25 fraksiyonda toplam 50 Gy olacak şekilde standartlaştırılmıştır. Dozimetrik parametrelerin karşılaştırılmasında eşleştirilmiş örneklem t-testi kullanılmıştır. Bulgular: FB-TVMAT ve DIBH-TVMAT planları karşılaştırıldığında, sırasıyla ortalama kalp dozları 8.9 Gy ve 5.4 Gy olarak bulunmuştur (p=0.000). DIBH-TVMAT planında sol akciğerin 5 Gy aldığı hacimde (V5) %6.2’lik bir azalma gözlenmiştir (p=0.01). Sağ akciğerin ortalama dozunda 1.3 Gy, yani %28 oranında anlamlı bir düşüş kaydedilmiştir (p=0.000). Ayrıca, sağ memeye alınan ortalama doz DIBH-TVMAT planında 0.7 Gy daha düşük bulunmuştur (p=0.000). Sonuç: Bulgular, DIBH tekniğinin TVMAT planlamasına entegre edilmesinin hedef hacim üzerinde yeterli doz kapsamı sağladığını ve sol meme kanseri nedeniyle mastektomi uygulanmış hastalarda kalp, LADCA, sol ve sağ akciğer ile karşı meme dozlarında anlamlı azalmalar sağladığını göstermektedir.

Anahtar Kelimeler

• Derin inspiryumda nefes tutma
• Tanjansiyel hacimsel modüleli ark terapisi
• Meme kanseri
• Radyoterapi
• Mastektomi

Proje Numarası

2020/32

Kaynakça

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