DBCG IMN2 研究中乳腺内结节照射的质量保证。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2024-11-08 DOI:10.1016/j.radonc.2024.110600

Lasse Refsgaard , Emma S. Buhl , Anders W. Mølby Nielsen , Mette S. Thomsen , Karen Andersen , Ingelise Jensen , Martin Berg , Ebbe L. Lorenzen , Lise B.J. Thorsen , Jens Overgaard , Stine S. Korreman , Birgitte V. Offersen , on behalf of the DBCG RT Committee

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引用次数: 0

摘要

目的/目标：丹麦乳腺癌小组（DBCG）IMN2 研究调查了结节阳性乳腺癌（BC）患者从乳腺内结节照射（IMNI）中获得的收益。IMNI适用于右侧患者，但不适用于左侧患者。靶区的划分基于骨性地标，这与当代基于血管的 ESTRO 共识指南不同。我们的目标是比较右侧和左侧患者的 IMNI 剂量：从 DBCG RT Nation 研究中收集了 2008 年至 14 年的治疗计划和划定结构，包括 CTVn_IMN（IMN_old）。在研究期间，仅在右侧患者中划定了 IMN_old。根据 ESTRO 指南（IMN_ESTRO）对右侧和左侧 CTVn_IMN 结构进行了自动分割。由于 IMN_old 和 IMN_ESTRO 的颅骨不一致，IMN_ESTRO 模型被分为 IMN_ESTRO_颅骨和 IMN_ESTRO_肋间隙(IC)1-3、IC1-4 和 IC4_only：有 2,837 名患者（占 IMN2 研究中患者的 62.5%）的治疗计划可供选择。在右侧患者中，IMN_old 的中位剂量覆盖率（92.4%）高于 IMN_ESTRO（71.7%），P 结论：对于 IMN_ESTRO_IC1-3，我们发现右侧患者的 IMN 剂量覆盖率明显高于左侧患者，支持根据研究指南进行治疗。

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Quality assurance of internal mammary node irradiation in the DBCG IMN2 study

Purpose/objective

The Danish Breast Cancer Group (DBCG) IMN2 study investigated the gain from internal mammary node irradiation (IMNI) in node-positive breast cancer patients. IMNI was indicated in right-sided patients, but not in left-sided. Target volume delineations were based on bony landmarks in contrast to the contemporary vessel-based ESTRO consensus guideline. Our objective was to compare IMNI doses in right-sided versus left-sided patients.

Material/methods

Treatment plans and delineated structures including CTVn_IMN (IMN_old) from 2008 to 2014 were collected from the DBCG RT Nation study. During the study period, IMN_old was only delineated in right-sided patients. Right and left-sided CTVn_IMN structures were auto-segmented following the ESTRO guidelines (IMN_ESTRO). Due to cranial discordance between IMN_old and IMN_ESTRO, the IMN_ESTRO models were separated into IMN_ESTRO_cranial and IMN_ESTRO_intercostal space(IC)1-3, IC1-4, and IC4_only.

Results

Treatment plans for 2837 patients were available (62.5 % of patients in the IMN2 study). In right-sided patients, the median IMN_old dose coverage (92.4 %) was higher than IMN_ESTRO (71.7 %), p < 0.001. Dose coverage in IMN_ESTRO_IC1-3 was comparable to IMN_old. Comparing IMN_ESTRO_IC1-3 in all patients by laterality, the median CTVn_V90% was 94.6 % (IQR 64.8–100.0) in right-sided patients and 20.4 % (IQR 0.9–55.8) in left-sided patients, p < 0.001. For right-sided patients, median CTV_V90% was 82.3 % in IMN_ESTRO_IC4_only. Median mean heart doses were lower in right-sided patients (1.2 Gy) than in left-sided (2.3 Gy), p < 0.001. Median mean lung doses were higher in right-sided patients (16.0 Gy) than in left-sided (12.7 Gy), p < 0.001.

Conclusion

For IMN_ESTRO_IC1-3, we found a significantly higher IMN dose coverage in right-sided than in left-sided patients supporting treatment according to study guidelines in the DBCG IMN2 study.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.