Publication: Radyoterapi tedavisinde erken evre sol meme kanseri hastalarının nefes kontrollü ve kontrolsüz hacimsel ayarlı ark terapi tekniği ile kalp dozlarının karşılaştırılması
Abstract
Amaç: Erken evre sol meme kanserli on kadın hastada normal nefes ve nefes tutmalıVMAT (hacimsel ayarlı ark terapi, Volumetric Modulated Arc Therapy) tedaviplanları hazırlanarak, DVH (Doz Volume Histogram) üzerinde riskli organların kalpve sol ön inen arter olan LAD (Left Anterior Descending) dozlarının iki planarasındaki farklarının incelenerek radyoterapi sonrası kalp üzerinde geç yan etkileriniazaltmak amaçlanmıştır.Gereç ve Yöntem: Solunum takip sistemi eşliğinde on sol meme kanserli hastanınNN (normal nefes) ve NT‟ li (nefes tutma) VMAT planları hazırlandı. Her hastanın ikigörüntüsü iki alanlı oluşturularak uygulanmadan önce 28 fraksiyon da dozun %95‟ itüm memeye 47 Gy, tümör yatağına eş zamanlı ek tedavi (SIB, SimultaneousIntegrated Boost) 60 Gy verilecek şekilde tedavi planlamaları hazırlandı. Bulgular: Kalbin maksimum doz değeri beklediğimiz gibi NT tekniği ile ortalama(31,76 ± 8,71 Gy), NN tekniği ile ortalama (40,56 ± 5,17 Gy)‟ ye göre % 22 oranda 8,8Gy azalma ile daha iyi sonuçlar elde edildi. Kalp ortalama doz değerinde de NTtekniği ile ortalama (2,58 ± 0,81 Gy), NN tekniği ile ortalama (3,79 ± 0,94 Gy)‟ yegöre % 32 oranda 1,2 Gy azalma ile daha iyi sonuçlar elde edildi. LAD ortalama dozdeğeri NT tekniği ile ortalama (5,88 ± 1,73 Gy), NN tekniği ile ortalama (8,61 ± 2,43Gy)‟ ye göre % 32 oranda düşüş ile 2,7 Gy azalma görüldü.Sonuçlar: VMAT NN ve NT teknikleri ile hazırlanan planlar da LAD, kalpmaksimum ve ortalama doz değerlerindeki azalma ile istatistiksel olarak anlamlı birfark bulunmuştur ( p=0,005). Böylece meme kanserli hastalarda radyoterapi sonrasıoluşabilecek kardiyak yan etkiler azaltılmıştır.
Objective: Our objective is to ensure improvement of post radiotherapy late hearteffects and to record a significant decrease of doses by VMAT (Volumetric ModulatedArc Therapy) technique performed with breath holdfor the treatment of of femalepatients with early stage left breast cancer. The differences between the two plans;normal breath (NB) and breath holding (BH) on the risky organ, the heart, with DVH(Dose Volume Histogram) and LAD (Left Anterior Descending) were determined.Materials and Methods: The VMAT plans with BH of ten patients were preparedwith the breath monitoring system. The treatment planning was made in order toprovide SIB (Simultaneous Integrated Boost) 60 Gy to the mass bed and 47 Gy toentire breast of 95% of the dosage at 28 fractions with two areas of both views of eachpatient before application.Findings: Maximum dose value of the heart provided as we expected better resultswith decrease of 22% 8,8 Gy of BH technique mean (31,76 ± 8,71 Gy) versus NBmean (40,56 ± 5,17 Gy). Similarly heart average dose value provided a better resultwith a decrease of 32% 1,2 Gy of BH technique mean (2,58 ± 0,81 Gy) versus NBtechnique mean (3,79 ± 0,94 Gy). LAD average dose value indicated a 32% 2,7 Gydecrease of BH technique mean (5,88 ± 1,73 Gy) versus NB technique mean (8,61 ±2,43 Gy).Results: A statistically significant difference with the decrease of LAD, heartmaximum and average dose values has been found of NB and BH techniqueperformed with VMAT ( p=0,005). Thus, cardiac side effects after radiotherapy inbreast cancer patients were reduced.
Objective: Our objective is to ensure improvement of post radiotherapy late hearteffects and to record a significant decrease of doses by VMAT (Volumetric ModulatedArc Therapy) technique performed with breath holdfor the treatment of of femalepatients with early stage left breast cancer. The differences between the two plans;normal breath (NB) and breath holding (BH) on the risky organ, the heart, with DVH(Dose Volume Histogram) and LAD (Left Anterior Descending) were determined.Materials and Methods: The VMAT plans with BH of ten patients were preparedwith the breath monitoring system. The treatment planning was made in order toprovide SIB (Simultaneous Integrated Boost) 60 Gy to the mass bed and 47 Gy toentire breast of 95% of the dosage at 28 fractions with two areas of both views of eachpatient before application.Findings: Maximum dose value of the heart provided as we expected better resultswith decrease of 22% 8,8 Gy of BH technique mean (31,76 ± 8,71 Gy) versus NBmean (40,56 ± 5,17 Gy). Similarly heart average dose value provided a better resultwith a decrease of 32% 1,2 Gy of BH technique mean (2,58 ± 0,81 Gy) versus NBtechnique mean (3,79 ± 0,94 Gy). LAD average dose value indicated a 32% 2,7 Gydecrease of BH technique mean (5,88 ± 1,73 Gy) versus NB technique mean (8,61 ±2,43 Gy).Results: A statistically significant difference with the decrease of LAD, heartmaximum and average dose values has been found of NB and BH techniqueperformed with VMAT ( p=0,005). Thus, cardiac side effects after radiotherapy inbreast cancer patients were reduced.