Dosimetric comparison between dIMRT and VMAT for bilateral breast cancer

中国辐射卫生 Pub Date : 2021-06-01 DOI:10.13491/J.ISSN.1004-714X.2021.03.016

Fan Xuemei, Hou Xin, L. Liang, XU Yumei, LI Liantao

{"title":"Dosimetric comparison between dIMRT and VMAT for bilateral breast cancer","authors":"Fan Xuemei, Hou Xin, L. Liang, XU Yumei, LI Liantao","doi":"10.13491/J.ISSN.1004-714X.2021.03.016","DOIUrl":null,"url":null,"abstract":"Objective To compare the dosimetric difference of target and organs-at-risk between intensity-modulated\n radiotherapy (dIMRT) and volumetric modulated arc therapy (VMAT) for bilateral breast\n cancer, so as to discuss the clinical feasibility of radiotherapy for bilateral breast\n cancer.\n Methods The clinical data of 18 patients receiving radical or modified radical mastectomy\n for confirmed bilateral breast cancer were enrolled in this study. dIMRT plans and\n VMAT plans were designed for each patient, and discuss the dosimetric data of two\n radiotherapy plans.\n Results Both the two plans satisfied the prescription. In terms of the homogeneity index,\n VMAT plans (0.09 ± 0.02) were superior to dIMRT plans (0.11 ± 0.1, P < 0.05). In terms of the conformity index,VMAT plans (0.82 ± 0.52) were superior\n to dIMRT plans (0.71 ± 0,51, P < 0.05). Furthermore, VMAT plans (0.98 ± 0.06) were superior to dIMRT plans (1.24\n ± 0.08, P < 0.05) in the dose gradient index. The V\n 10, V\n 20, V\n 30 and D\n mean of lungs in VMAT plans (39.07 ± 4.92, 22.19 ± 4.36, 12.81 ± 4.71, 1 309.03 ± 135.55)\n were higher than those in dIMRT plans (30.34 ± 4.26, 17.56 ± 4.31, 6.77 ± 3.93, 1\n 201.39 ± 166.77, P < 0.05). Meanwhile, the V\n 5 of lungs in VMAT plans (63.36 ± 9.02) was higher than that in dIMRT plans (58.01\n ± 7.17, P > 0.05). However, the V\n 5, V\n 30 and D\n mean of heart in VMAT plans (51.98 ± 3.60, 3.78 ± 1.76, 885.89 ± 59.84) were lower than\n those in dIMRT plans (77.16 ± 12.11, 5.22 ± 2.85, 1 036.96 ± 151.46, P < 0.05). The D\n max of spinal cord in VMAT plans (2 150.42 ± 136.19) was significantly lower than that\n in dIMRT plans (3 008.23 ± 304.15, P < 0.05), Monitor units in VMAT plans (792.61 ± 62.53) was significantly lower than\n that in dIMRT plans (3 225.33 ± 498.66, P < 0.05).\n Conclusion Although VMAT has many advantages: achieves better homogeneity index and conformity\n index of target areas, reduces the irradiation dose of organs-at-risk, especially,\n the irradiation dose of heart and spinal cord is significantly reduced, however, it\n increases the irradiation dose of lungs. To reduce the recurrence of grade ≥ 2 radiation\n pneumonia, dIMRT should be better considered in the application of radiotherapy for\n bilateral breast cancer.\n 摘要：目的对比双侧乳腺癌术后放疗采用动态调强技术 (dIMRT) 和容积旋转调强技术 (VMAT) 时靶区和危及器官的剂量学差异, 探索临床应用的可行性。\n 方法选择 18 例双侧乳腺癌术后行全乳放疗的患者, 分别设计 dIMRT 和 VMAT 两组计划, 比较分析剂量学参数。\n 结果两种治疗技术均能满足处方要求, 其中 VMAT 组的靶区均匀性指数 (0.09 ± 0.02) 优于 dIMRT 组 (0.11 ± 0.01), 适形度指数 (0.82\n ± 0.52) 优于 dIMRT 组 (0.71 ± 0.51), 剂量梯度指数 (0.98 ± 0.06) 优于 dIMRT 组 (1.24 ± 0.08), 差异均具有统计学意义\n (\n P < 0.05); VMAT 组双肺的 V\n 10、\n V\n 20、\n V\n 30 和 D\n mean (39.07 ± 4.92, 22.19 ± 4.36, 12.81 ± 4.71, 1 309.03 ± 135.55) 均高于 dIMRT 组 (30.34\n ± 4.26, 17.56 ± 4.31, 6.77 ± 3.93, 1 201.39 ± 166.77), 差异具有统计学意义 (\n P < 0.05), VMAT 组双肺的\n V\n 5 (63.36 ± 9.02) 高于 dIMRT (58.01 ± 7.17), 差异无统计学意义 (\n P > 0.05); VMAT 组心脏的 V\n 5、\n V\n 30 和 D\n mean (51.98 ± 3.60, 3.78 ± 1.76, 885.89 ± 59.84) 均明显低于 dIMRT 组 (77.16 ± 12.11, 5.22 ±\n 2.85, 1 036.96 ± 151.46), 差异具有统计学意义 (\n P < 0.05); VMAT 组脊髓的 D\n max (2150.42 ± 136.19) 较 dIMRT 组 (3008.23 ± 304.15) 减少, 差异具有统计学意义 (\n P < 0.05); VMAT 组机器跳数 (792.61 ± 62.53) 较 dIMRT 组 (3225.33 ±498.66)明显减少, 差异具有统计学意义 (\n P < 0.05)。\n 结论 VMAT 技术可使靶区剂量分布拥有更好的均匀性和适形性, 且拥有更少的高剂量区域。在危及器官受量方面, VMAT 技术可显著降低心脏和脊髓受量, 但双肺的受照剂量增加。在临床应用中,\n 选择 dIMRT 技术更为合适, 可降低发生 ≥2 级症状性 RP 的风险。","PeriodicalId":58844,"journal":{"name":"中国辐射卫生","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"中国辐射卫生","FirstCategoryId":"1087","ListUrlMain":"https://doi.org/10.13491/J.ISSN.1004-714X.2021.03.016","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Objective To compare the dosimetric difference of target and organs-at-risk between intensity-modulated radiotherapy (dIMRT) and volumetric modulated arc therapy (VMAT) for bilateral breast cancer, so as to discuss the clinical feasibility of radiotherapy for bilateral breast cancer. Methods The clinical data of 18 patients receiving radical or modified radical mastectomy for confirmed bilateral breast cancer were enrolled in this study. dIMRT plans and VMAT plans were designed for each patient, and discuss the dosimetric data of two radiotherapy plans. Results Both the two plans satisfied the prescription. In terms of the homogeneity index, VMAT plans (0.09 ± 0.02) were superior to dIMRT plans (0.11 ± 0.1, P < 0.05). In terms of the conformity index,VMAT plans (0.82 ± 0.52) were superior to dIMRT plans (0.71 ± 0,51, P < 0.05). Furthermore, VMAT plans (0.98 ± 0.06) were superior to dIMRT plans (1.24 ± 0.08, P < 0.05) in the dose gradient index. The V 10, V 20, V 30 and D mean of lungs in VMAT plans (39.07 ± 4.92, 22.19 ± 4.36, 12.81 ± 4.71, 1 309.03 ± 135.55) were higher than those in dIMRT plans (30.34 ± 4.26, 17.56 ± 4.31, 6.77 ± 3.93, 1 201.39 ± 166.77, P < 0.05). Meanwhile, the V 5 of lungs in VMAT plans (63.36 ± 9.02) was higher than that in dIMRT plans (58.01 ± 7.17, P > 0.05). However, the V 5, V 30 and D mean of heart in VMAT plans (51.98 ± 3.60, 3.78 ± 1.76, 885.89 ± 59.84) were lower than those in dIMRT plans (77.16 ± 12.11, 5.22 ± 2.85, 1 036.96 ± 151.46, P < 0.05). The D max of spinal cord in VMAT plans (2 150.42 ± 136.19) was significantly lower than that in dIMRT plans (3 008.23 ± 304.15, P < 0.05), Monitor units in VMAT plans (792.61 ± 62.53) was significantly lower than that in dIMRT plans (3 225.33 ± 498.66, P < 0.05). Conclusion Although VMAT has many advantages: achieves better homogeneity index and conformity index of target areas, reduces the irradiation dose of organs-at-risk, especially, the irradiation dose of heart and spinal cord is significantly reduced, however, it increases the irradiation dose of lungs. To reduce the recurrence of grade ≥ 2 radiation pneumonia, dIMRT should be better considered in the application of radiotherapy for bilateral breast cancer. 摘要：目的对比双侧乳腺癌术后放疗采用动态调强技术 (dIMRT) 和容积旋转调强技术 (VMAT) 时靶区和危及器官的剂量学差异, 探索临床应用的可行性。方法选择 18 例双侧乳腺癌术后行全乳放疗的患者, 分别设计 dIMRT 和 VMAT 两组计划, 比较分析剂量学参数。结果两种治疗技术均能满足处方要求, 其中 VMAT 组的靶区均匀性指数 (0.09 ± 0.02) 优于 dIMRT 组 (0.11 ± 0.01), 适形度指数 (0.82 ± 0.52) 优于 dIMRT 组 (0.71 ± 0.51), 剂量梯度指数 (0.98 ± 0.06) 优于 dIMRT 组 (1.24 ± 0.08), 差异均具有统计学意义 ( P < 0.05); VMAT 组双肺的 V 10、 V 20、 V 30 和 D mean (39.07 ± 4.92, 22.19 ± 4.36, 12.81 ± 4.71, 1 309.03 ± 135.55) 均高于 dIMRT 组 (30.34 ± 4.26, 17.56 ± 4.31, 6.77 ± 3.93, 1 201.39 ± 166.77), 差异具有统计学意义 ( P < 0.05), VMAT 组双肺的 V 5 (63.36 ± 9.02) 高于 dIMRT (58.01 ± 7.17), 差异无统计学意义 ( P > 0.05); VMAT 组心脏的 V 5、 V 30 和 D mean (51.98 ± 3.60, 3.78 ± 1.76, 885.89 ± 59.84) 均明显低于 dIMRT 组 (77.16 ± 12.11, 5.22 ± 2.85, 1 036.96 ± 151.46), 差异具有统计学意义 ( P < 0.05); VMAT 组脊髓的 D max (2150.42 ± 136.19) 较 dIMRT 组 (3008.23 ± 304.15) 减少, 差异具有统计学意义 ( P < 0.05); VMAT 组机器跳数 (792.61 ± 62.53) 较 dIMRT 组 (3225.33 ±498.66)明显减少, 差异具有统计学意义 ( P < 0.05)。结论 VMAT 技术可使靶区剂量分布拥有更好的均匀性和适形性, 且拥有更少的高剂量区域。在危及器官受量方面, VMAT 技术可显著降低心脏和脊髓受量, 但双肺的受照剂量增加。在临床应用中, 选择 dIMRT 技术更为合适, 可降低发生 ≥2 级症状性 RP 的风险。

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dIRT与VMAT治疗双侧癌症的剂量比较

Objective To compare the dosymetric difference of target and organs at risk between intensive modulated radiation (dIMRT) and volumetric modulated arc therapy (VMAT) for bilateral break cancer, so as to discuss the clinical feasibility of radiation for bilateral break cancer Methods The clinical data of 18 patients receiving radio or modified radio mast for confirmed bilateral breast cancer were enrolled in this study DIMRT plans and VMAT plans were designed for each patient, and discussed the dosymetric data of two radiapy plans Results Both the two plans satisfied the subscription In terms of the homogeneity index, VMAT plans (0.09 ± 0.02) were superior to dIMRT plans (0.11 ± 0.1, P<0.05) The V 10, V 20, V 30, and D mean of lungs in VMAT plans (39.07 ± 4.92, 22.19 ± 4.36, 12.81 ± 4.71, 1 309.03 ± 135.55) were higher than that in dIMRT plans (30.34 ± 4.26, 17.56 ± 4.31, 6.77 ± 3.93, 1 201.39 ± 166.77, P<0.05). Meanwhile, the V 5 of lungs in VMAT plans (63.36 ± 9.02) was higher than that in dIMRT plans (58.01 ± 7.17, P>0.05). However, the V 5, V 30 and D mean of heart in VMAT plans (51.98 ± 3.60, 3.78 ± 1.76, 885.89 ± 59.84) were lower than that in dIMRT plans (77.16 ± 12.11, 5.22 ± 2.85, 1 036.96 ± 151.46, P<0.05). The D max of spin core in VMAT plans (2 150.42 ± 136.19) was significantly lower than that in dIMRT plans (3 008.23 ± 304.15, P<0.05), Monitor units in VMAT plans (792.61 ± 62.53) were significantly lower than that in dIMRT plans (3 225.33 ± 498.66, P<0.05). UCED, HOWEVER, It increases the radiation dose of lungs To reduce the recurrence of grade ≥ 2 radiation pneumonia, dIMRT should be better considered in the application of radiation for bilateral break cancer Abstract: Objective To compare the dosimetry differences of target area and endangered organs in bilateral breast cancer postoperative radiotherapy using dynamic intensity modulation technology (dIMRT) and volume rotation intensity modulation technology (VMAT), and explore the feasibility of clinical application. Methods Eighteen patients with bilateral breast cancer who received whole breast radiotherapy after surgery were selected, and two groups of plans, dIMRT and VMAT, were designed respectively. Dosimetric parameters were compared and analyzed. The results showed that both treatment techniques were able to meet the prescription requirements, with the target area uniformity index (0.09 ± 0.02) in the VMAT group being better than that in the dIMRT group (0.11 ± 0.01), the fitness index (0.82 ± 0.52) being better than that in the dIMRT group (0.71 ± 0.51), and the dose gradient index (0.98 ± 0.06) being better than that in the dIMRT group (1.24 ± 0.08). The differences were statistically significant (P<0.05); The V 10, V 20, V 30, and D mean (39.07 ± 4.92, 22.19 ± 4.36, 12.81 ± 4.71, 1309.03 ± 135.55) in both lungs of the VMAT group were higher than those of the dIMRT group (30.34 ± 4.26, 17.56 ± 4.31, 6.77 ± 3.93, 1201.39 ± 166.77), with statistically significant differences (P<0.05). The V 5 (63.36 ± 9.02) in both lungs of the VMAT group was higher than that of the dIMRT group (58.01 ± 7.17), with no statistically significant differences (P>0.05); The V 5, V 30, and D mean (51.98 ± 3.60, 3.78 ± 1.76, 885.89 ± 59.84) of the VMAT group were significantly lower than those of the dIMRT group (77.16 ± 12.11, 5.22 ± 2.85, 1036.96 ± 151.46), with statistical significance (P<0.05); The D max of the spinal cord in the VMAT group (2150.42 ± 136.19) decreased compared to the dIMRT group (3008.23 ± 304.15), and the difference was statistically significant (P<0.05); The number of machine hops in the VMAT group (792.61 ± 62.53) was significantly reduced compared to the dIMRT group (3225.33 ± 498.66), and the difference was statistically significant (P<0.05). Conclusion: VMAT technology can achieve better uniformity and conformability of target dose distribution, with fewer high-dose areas. In terms of endangering organ exposure, VMAT technology can significantly reduce cardiac and spinal cord exposure, but the exposure dose to both lungs increases. In clinical applications, it is more appropriate to choose dIMRT technology, which can reduce the risk of developing ≥ 2-grade symptomatic RP.

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来源期刊

中国辐射卫生

CiteScore

0.80

自引率

0.00%

发文量

7142

期刊介绍： Chinese Journal of Radiological Health is one of the Source Journals for Chinese Scientific and Technical Papers and Citations and belongs to the series published by Chinese Preventive Medicine Association (CPMA). It is a national academic journal supervised by National Health Commission of the People’s Republic of China and co-sponsored by Institute of Radiation Medicine, Shandong Academy of Medical Sciences and CPMA, and is a professional academic journal publishing research findings and management experience in the field of radiological health, issued to the public in China and abroad. Under the guidance of the Communist Party of China and the national press and publication policies, the Journal actively publicizes the guidelines and policies of the Party and the state on health work, promotes the implementation of relevant laws, regulations and standards, and timely reports new achievements, new information, new methods and new products in the specialty, with the aim of organizing and promoting the academic communication of radiological health in China and improving the academic level of the specialty, and for the purpose of protecting the health of radiation workers and the public while promoting the extensive use of radioisotopes and radiation devices in the national economy. The main columns include Original Articles, Expert Comments, Experience Exchange, Standards and Guidelines, and Review Articles.