Alessandro Clivio, Daniel R Zwahlen, Sonja Koch, Cezarina Negreanu, Enrico Barletta, Helmut Haerle, Elena Hofmann, Christoph Oehler
{"title":"在为接受锁骨上结节照射的乳腺癌患者制定治疗计划时避开甲状腺。","authors":"Alessandro Clivio, Daniel R Zwahlen, Sonja Koch, Cezarina Negreanu, Enrico Barletta, Helmut Haerle, Elena Hofmann, Christoph Oehler","doi":"10.1007/s00066-024-02321-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Hypothyroidism affects up to 21% of women with breast cancer after supraclavicular node irradiation. The PENTEC (pediatric normal tissue effects in the clinic) initiative highlighted the need to minimize the thyroid dose, albeit without giving a specific constraint. This study aimed to define a reasonable target thyroid mean dose (D<sub>mean</sub>) between 10 and 15 Gy using intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) and examine its impact on the hypothyroidism risk.</p><p><strong>Methods: </strong>Forty-three breast cancer patients with supraclavicular irradiation neglecting the thyroid in terms of dose protection were included from 01/2020 to 04/2021. An IMRT or VMAT technique was used in 23 and 20 patients, respectively. Replanning aimed for a thyroid D<sub>mean</sub> of 10 Gy. IMRT plans still exceeding 10 Gy were converted into VMAT plans. Fisher's sign test compared original and revised plans and the hypothyroidism risk was calculated.</p><p><strong>Results: </strong>Initial radiotherapy plans had a thyroid D<sub>mean</sub> of 18.4 ± 7.9 Gy (IMRT: 20.4 ± 8.8 Gy, VMAT: 16.2 ± 6.2 Gy). Replanning significantly reduced D<sub>mean</sub> to 10.3 ± 4.5 Gy (-44%) overall (IMRT: -50%, VMAT: -35%), with 56% achieving ≤ 10 Gy (IMRT: 33.3%, VMAT: 61%). Furthermore, an IMRT to VMAT conversion yielded a thyroid D<sub>mean</sub> of 9.2 ± 3.5 Gy, with 74.4% of patients ≤ 10 Gy, albeit at the cost of higher doses to the contralateral breast. Clinical and planning target volume (CTV/PTV) coverage remained uncompromised. The calculated hypothyroidism risk significantly decreased from 24.5% to 13.3% (D<sub>mean</sub> = 10 Gy) or 16.3% (D<sub>mean</sub> = 13.5 Gy).</p><p><strong>Conclusion: </strong>Implementing a thyroid organ at risk (OAR) constraint D<sub>mean</sub> of 13.5 Gy was feasible in 88% of patients without compromising other OARs and CTV/PTV coverage, and resulted in a 33-46% reduction of the hypothyroidism risk.</p><p><strong>Trial registration: </strong>Retrospectively registered.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Thyroid avoidance in treatment planning for breast cancer patients irradiated to the supraclavicular nodes.\",\"authors\":\"Alessandro Clivio, Daniel R Zwahlen, Sonja Koch, Cezarina Negreanu, Enrico Barletta, Helmut Haerle, Elena Hofmann, Christoph Oehler\",\"doi\":\"10.1007/s00066-024-02321-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Hypothyroidism affects up to 21% of women with breast cancer after supraclavicular node irradiation. The PENTEC (pediatric normal tissue effects in the clinic) initiative highlighted the need to minimize the thyroid dose, albeit without giving a specific constraint. This study aimed to define a reasonable target thyroid mean dose (D<sub>mean</sub>) between 10 and 15 Gy using intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) and examine its impact on the hypothyroidism risk.</p><p><strong>Methods: </strong>Forty-three breast cancer patients with supraclavicular irradiation neglecting the thyroid in terms of dose protection were included from 01/2020 to 04/2021. An IMRT or VMAT technique was used in 23 and 20 patients, respectively. Replanning aimed for a thyroid D<sub>mean</sub> of 10 Gy. IMRT plans still exceeding 10 Gy were converted into VMAT plans. Fisher's sign test compared original and revised plans and the hypothyroidism risk was calculated.</p><p><strong>Results: </strong>Initial radiotherapy plans had a thyroid D<sub>mean</sub> of 18.4 ± 7.9 Gy (IMRT: 20.4 ± 8.8 Gy, VMAT: 16.2 ± 6.2 Gy). Replanning significantly reduced D<sub>mean</sub> to 10.3 ± 4.5 Gy (-44%) overall (IMRT: -50%, VMAT: -35%), with 56% achieving ≤ 10 Gy (IMRT: 33.3%, VMAT: 61%). Furthermore, an IMRT to VMAT conversion yielded a thyroid D<sub>mean</sub> of 9.2 ± 3.5 Gy, with 74.4% of patients ≤ 10 Gy, albeit at the cost of higher doses to the contralateral breast. Clinical and planning target volume (CTV/PTV) coverage remained uncompromised. The calculated hypothyroidism risk significantly decreased from 24.5% to 13.3% (D<sub>mean</sub> = 10 Gy) or 16.3% (D<sub>mean</sub> = 13.5 Gy).</p><p><strong>Conclusion: </strong>Implementing a thyroid organ at risk (OAR) constraint D<sub>mean</sub> of 13.5 Gy was feasible in 88% of patients without compromising other OARs and CTV/PTV coverage, and resulted in a 33-46% reduction of the hypothyroidism risk.</p><p><strong>Trial registration: </strong>Retrospectively registered.</p>\",\"PeriodicalId\":21998,\"journal\":{\"name\":\"Strahlentherapie und Onkologie\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-11-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Strahlentherapie und Onkologie\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00066-024-02321-8\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Strahlentherapie und Onkologie","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00066-024-02321-8","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Thyroid avoidance in treatment planning for breast cancer patients irradiated to the supraclavicular nodes.
Purpose: Hypothyroidism affects up to 21% of women with breast cancer after supraclavicular node irradiation. The PENTEC (pediatric normal tissue effects in the clinic) initiative highlighted the need to minimize the thyroid dose, albeit without giving a specific constraint. This study aimed to define a reasonable target thyroid mean dose (Dmean) between 10 and 15 Gy using intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) and examine its impact on the hypothyroidism risk.
Methods: Forty-three breast cancer patients with supraclavicular irradiation neglecting the thyroid in terms of dose protection were included from 01/2020 to 04/2021. An IMRT or VMAT technique was used in 23 and 20 patients, respectively. Replanning aimed for a thyroid Dmean of 10 Gy. IMRT plans still exceeding 10 Gy were converted into VMAT plans. Fisher's sign test compared original and revised plans and the hypothyroidism risk was calculated.
Results: Initial radiotherapy plans had a thyroid Dmean of 18.4 ± 7.9 Gy (IMRT: 20.4 ± 8.8 Gy, VMAT: 16.2 ± 6.2 Gy). Replanning significantly reduced Dmean to 10.3 ± 4.5 Gy (-44%) overall (IMRT: -50%, VMAT: -35%), with 56% achieving ≤ 10 Gy (IMRT: 33.3%, VMAT: 61%). Furthermore, an IMRT to VMAT conversion yielded a thyroid Dmean of 9.2 ± 3.5 Gy, with 74.4% of patients ≤ 10 Gy, albeit at the cost of higher doses to the contralateral breast. Clinical and planning target volume (CTV/PTV) coverage remained uncompromised. The calculated hypothyroidism risk significantly decreased from 24.5% to 13.3% (Dmean = 10 Gy) or 16.3% (Dmean = 13.5 Gy).
Conclusion: Implementing a thyroid organ at risk (OAR) constraint Dmean of 13.5 Gy was feasible in 88% of patients without compromising other OARs and CTV/PTV coverage, and resulted in a 33-46% reduction of the hypothyroidism risk.
期刊介绍：
Strahlentherapie und Onkologie, published monthly, is a scientific journal that covers all aspects of oncology with focus on radiooncology, radiation biology and radiation physics. The articles are not only of interest to radiooncologists but to all physicians interested in oncology, to radiation biologists and radiation physicists. The journal publishes original articles, review articles and case studies that are peer-reviewed. It includes scientific short communications as well as a literature review with annotated articles that inform the reader on new developments in the various disciplines concerned and hence allow for a sound overview on the latest results in radiooncology research.
Founded in 1912, Strahlentherapie und Onkologie is the oldest oncological journal in the world. Today, contributions are published in English and German. All articles have English summaries and legends. The journal is the official publication of several scientific radiooncological societies and publishes the relevant communications of these societies.
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