减少左前降支和左心室器官剂量在左侧乳腺癌放疗计划中的策略。

IF 1.9 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Reviews in cardiovascular medicine Pub Date : 2025-02-21 eCollection Date: 2025-02-01 DOI:10.31083/RCM26366
Umut Diremsizoglu, Nezihan Topal, Aykut Oguz Konuk, Ibrahim Halil Suyusal, Dogacan Genc, Onur Ari, Hasan Furkan Cevik, Aysegul Ucuncu Kefeli, Maksut Gorkem Aksu, Emine Binnaz Sarper
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引用次数: 0

摘要

背景:乳腺癌放疗最显著的长期毒性之一是主要心脏不良事件(MACE)。在目前的放疗实践中,心脏平均剂量是最常用的参数。本研究的目的是通过将左前降支(LAD)和左心室(LV)纳入放射治疗计划,同时保持左侧乳腺癌患者足够的剂量覆盖,从而降低左前降支(LAD)和左心室(LV)的危险器官(OAR)剂量。方法:我们回顾性分析在科凯埃利大学医学院治疗的左侧乳腺癌病例。只有局部和局部晚期乳腺癌患者被纳入分析。共有77名患者在2020年至2024年间接受了治疗。将LAD和LV的剂量加入到优化算法中。为每位患者创建了两个体积调制弧线治疗(VMAT)计划。共制作了154个方案,包括标准方案、LAD和LV节约方案。结果:VMAT各方案在计划靶体积(PTV) D2、D50、D98 (PTV接受剂量体积为2%、50%、98%)方面差异均无统计学意义(p < 0.05)。然而,心脏V5(接受至少5格雷(Gy)的心脏百分比)和平均心脏剂量显著降低。与左室和左室保留方案相比,标准方案的平均心脏剂量降低(p < 0.001)。同样,心脏V5值明显降低(p < 0.001)。此外,重新优化后,所有LAD和LV参数均显着降低。结论:通过将LAD和LV桨加入优化算法,我们实现了所有心脏、LAD和LV参数的显著降低,而没有改变计划的治疗体积覆盖率。通过实施这一战略,可以显著降低MACE的潜在风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Strategies to Reduce Left Anterior Descending Artery and Left Ventricle Organ Doses in Radiotherapy Planning for Left-Sided Breast Cancer.

Background: One of the most significant long-term toxicities of breast cancer radiotherapy is major adverse cardiac events (MACE). In current radiotherapy practice, the mean heart dose is the most commonly used parameter. The aim of our study was to reduce the doses of organs at risk (OAR) in the left anterior descending artery (LAD) and left ventricle (LV) by including the LAD and LV in planning radiotherapy while maintaining adequate dose coverage for patients with left-sided breast cancer.

Methods: We retrospectively analyzed left-sided breast cancer cases treated at the Kocaeli University Faculty of Medicine. Only patients with local and locally advanced breast cancer were included in the analysis. A total of 77 patients who were treated between 2020 and 2024 were included. The doses to the LAD and LV were added to the optimization algorithms. Two volumetric modulated arc therapy (VMAT) plans were created for each patient. A total of 154 plans were made, including standard and LAD and LV sparing plans.

Results: There was no statistically significant difference in all VMAT plans regarding planning target volume (PTV) D2, D50, and D98 (dose receiving volume of PTV 2%, 50%, and 98%) (p > 0.05). However, a significant decrease was observed in heart V5 (the percentage of the heart receiving at least 5 gray (Gy)) and mean heart dose. A decrease in the mean heart dose was observed in the standard plan compared with the LAD and LV sparing plan (p < 0.001). Similarly, the heart V5 value decreased significantly (p < 0.001). Additionally, significant reductions were measured in all LAD and LV parameters after re-optimization.

Conclusions: We achieved significant reductions in all heart, LAD, and LV parameters without making any changes to the planned treatment volume coverage by adding LAD and LV OARs to the optimization algorithms. The potential risk of MACE can be significantly reduced by implementing this strategy.

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来源期刊
Reviews in cardiovascular medicine
Reviews in cardiovascular medicine 医学-心血管系统
CiteScore
2.70
自引率
3.70%
发文量
377
审稿时长
1 months
期刊介绍: RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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