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

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. 1. Aksoy, Y. E., Ceber Turfan, E., Sert, E., ve Mermer, G. Barriers on Breast Cancer Early Detection Methods. Türkiye Meme Hastalıkları Dernekleri Federasyonu., The Journal of Breast Health. (2015);11(1), 26–30.
2. 2. Kurt, H., Keskek, S. O., Çil, T., ve Canataroǧlu, A. Complementary/alternative therapies in patients with breast cancer. Turk Onkoloji Dergisi. Adana. (2013);28(1), 10–15.
3. 3. Whelan, T. J., Olivotto, I. A., Parulekar, W. R., Ackerman, I., Chua, B. H., et al. Regional Nodal Irradiation in Early-Stage Breast Cancer. New England Journal of Medicine. (2015);373(4), 307–316.
4. 4. Taylor, C. W., & Kirby, A. M. Cardiac Side-effects From Breast Cancer Radiotherapy. Clinical Oncology. (2015);27(11), 621–629.
5. 5. Agrawal, R. K., Aird, E. G. A., Barrett, J. M., Barrett-Lee, P. J., Bentzen, S. M., et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. The Lancet. (2008); 371(9618), 1098–1107.
6. 6. Rault, E., Lacornerie, T., Dang, H. P., Crop, F., Lartigau, E., et al. Accelerated partial breast irradiation using robotic radiotherapy: A dosimetric comparison with tomotherapy and threedimensional conformal radiotherapy. Radiation Oncology. (2016);11(1), 1–8.
7. 7. Njeh, C. F., Saunders, M. W., & Langton, C. M. Accelerated Partial Breast Irradiation (APBI): A review of available techniques. Radiation Oncology. (2010);5(1), 1–28.
8. 8. Cholewka, A., Szlag, M., Białas, B., Kellas-Śleczka, S., Ślosarek, K. The importance of the implant quality in APBI - Gliwice experience. Dosimetric evaluation. Journal of Contemporary Brachytherapy. (2013);5(4), 227–231.

9. 9. Li, X. A., Tai, A., Arthur, D. W., Buchholz, T. A., Macdonald, S., et al. Variability of Target and Normal Structure Delineation for Breast Cancer Radiotherapy: An RTOG Multi-Institutional and Multiobserver Study. International Journal of Radiation Oncology Biology Physics. (2009);73(3), 944–951.
10. 10. B.C. John Choa,b, Coen W. Hurkmansa , Eugene M.F. Damena , Lambert J. Zijpa , Ben J. Mijnheer ., Intensity modulated versus non-intensity modulated radiotherapy in the treatment of the left breast and upper internal mammary lymph node chain: a comparative planning study. Radiotherapy and Oncology. (2002);62(3), 127–136
11. 11. Soile Tapio. Pathology and biology of radiation-induced cardiac disease. Journal of Radiation Research, 2016; 57(5), 439–448
12. 12. Laxmi S. Mehta, MD, FAHA, Chair Karol E. Et al. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect A Scientific Statement From the American Heart Association., American Heart Association. Circulation. 2018; 137(8), 30-66
13. 13. Carolyn W. Taylor, DPhil, FRCR, Zhe Wang, et al. Exposure of the Heart in Breast Cancer Radiation Therapy: A Systematic Review of Heart Doses Published During 2003 to 2013. International Journal of Radiation Oncology*Biology*Physics. 2015;93(4), 845-853
14. 14. K. Kikuchi (Koji), H. Koyama (Hideki), H. Masuda (H.), Y. Nomura (Y.), DS Sakai (Debbie), et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials Early Breast Cancer Trialists’ Collaborative Group (EBCTCG)., Lancet. 2005; 366(9503), 2087–2106
15. 15. Benedict, S. H., Yenice, K. M., Followill, D., Galvin, J. M., Hinson, W., et al. Stereotactic body radiation therapy: The report of AAPM Task Group 101. Medical Physics. 2011;37(8), 4078–4101.
16. 16. R. Ciérvide · Á. Montero · G. Potdevin · J. García· M. G. Aranda · B. Álvarez · et al. 5‑year results of accelerated partial breast irradiation (APBI) with SBRT (stereotactic body radiation therapy) and exactrac adaptive gating (Novalis®) for very early breast cancer patients: was it all worth it. Clinical and Translational Oncology. (2021); 23:2358–2367
17. 17. Jamesl. Bedford,Ph.D.,Andalanp. Warrıngton, M.Sc. Commıssıonıng Of Volumetrıc Modulated Arc Therapy (Vmat). International Journal of Radiation Oncology*Biology*Physics. 2009;73(2), 537-545
18. 18. Gibbs, I. C. Frameless İmage-Guided İntracranial And Extracranial Radiosurgery Using The Cyberknifetm Robotic System. Cancer/Radiotherapie, (2006);10(5), 283–287.
19. 19. Kurup, G. CyberKnife: A new paradigm in radiotherapy. Journal of Medical Physics. 2010; 35(2), 63–64
20. 20. Lee, C. Y., Kim, W. C., Kim, H. J., Lee, J., Park, S., & Huh, H. Do. Dosimetric Plan Comparison of Accelerated Partial Breast Irradiation (APBI) Using CyberKnife. Progress in Medical Physics. (2018);29(2), 73-80
21. 21. Vermeulen, S., Cotrutz, C., Morris, A., Meier, R., Buchanan, C., et al. Accelerated partial breast irradiation: Using the CyberKnife as the radiation delivery platform in the treatment of early breast cancer. Frontiers in Oncology. 2011;1(NOV), 1–8
22. 22. L. M. Goggin, PhD1 , M. Descovich, PhD1 , C. McGuinness, PhD1 , S. Shiao, MD, PhD1 , J. Pouliot, PhD1 , and C. Park, MD1. Dosimetric Comparison Between 3-Dimensional Conformal and Robotic SBRT Treatment Plans for Accelerated Partial Breast Radiotherapy. Technology in Cancer Research & Treatment. 2016;15(3), 437-445
23. 23. Lozza, L., Fariselli, L., Sandri, M., Rampa, M., Pinzi, V., et al. Partial breast irradiation with CyberKnife after breast conserving surgery: A pilot study in early breast cancer. Radiation Oncology. 2018;13(1), 1–11.