Partial-Volume Segmentation for Dose Optimization in Whole-Breast Radiotherapy
Tóm tắt
To analyze the dosimetric and clinical benefit of a forward planned technique to optimize dose distribution in whole-breast irradation (WBI) using additional partial-volume segments (PVSeg). In two separate treatment periods, 265 breast cancer patients received tangential-field WBI and were retrospectively analyzed. Between 02/2004 and 03/2006, 96 patients were treated with one to two additional low-weighted PVSeg to reduce dose peaks within the target volume. 169 patients treated between 01/2000 and 12/2001 before implementation of this PVSeg technique served as comparison group. Total dose was 50–50.4 Gy (single dose, 1.8–2 Gy). The planning target volume (PTV) receiving at least 95%, 105% and 110% of the reference dose (V95–110%) and frequency of moist skin desquamation during radiotherapy were compared uni- and multivariately with patient- and treatment-related variables. The mean PTV was 1,144 ml (range, 235–2,365 ml). Moist skin desquamations developed in 16 patients (17%) with PVSeg compared to 30 patients (18%) without PVSeg (p = 0.482). In breast volumes > 1,100 ml, the corresponding figures were 19% versus 29% (p = 0.133). V105% was significantly reduced by the use of PVSeg (82 ± 51 ml vs. 143 ± 129 ml; p < 0.0001). In univariate analysis, the following variables had significant influence on the development of moist skin desquamation: V95% (p < 0.0001), V105% (p < 0.001), V110% (p = 0.012) adjuvant chemotherapy (p = 0.02), and single dose (p = 0.009). In multivariate analysis, only V95% (p = 0.002) remained significant. The use of PVSeg in WBI reduced dose peaks within the PTV while breast volumes > 1,100 ml benefited most. V95% was strongly correlated to the risk of developing moist skin desquamations.
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