Yazarlar : Hurkmans CW, Dijckmans I, Reijnen M, van der Leer J, van Vliet-Vroegindeweij C, van der Sangen M.

Yayın : Radiother Oncol.

Yayın Yılı : 2012

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/22280808

Konu : Radyasyon Onkolojisi

Literatür İçeriği :

Abstract

PURPOSE:

It has been shown that seroma volumes decrease during breast conserving radiotherapy in a significant percentage of patients. We report on our experience with an adaptive radiation therapy (ART) strategy involving rescanning and replanning patients to take this reduction into account during a course of intensity-modulated radiation therapy with simultaneously integrated boost (IMRT-SIB).

MATERIALS:

From April 2007 till December 2009, 1274 patients eligible for SIB treatment were enrolled into this protocol. Patients for which the time between the initial planning CT (CT(1)) and lumpectomy was less than 30days and who had an initial seroma volume >30cm(3) were rescanned at day 10 of treatment (CT(2)) and replanned when significant changes were observed by the radiation oncologist. Patients received 28 fractions of 1.81Gy to the breast and 2.30Gy to the boost volume.

RESULTS:

Nine percent (n=113) of the 1274 patients enrolled met the criteria and were rescanned. Of this group, 77% (n=87) of treatment plans were adapted. Time between surgery and CT(1) (20days versus 20days for adapted and non-adapted plans, p=0.89) and time between CT(1) and CT(2) (21days versus 22days for adapted and non-adapted plans, p=0.43) revealed no procedural differences which might have biased our results. In the adapted plans, seroma decreased significantly from 60 to 27cm(3) (p<0.001), TBV from 70 to 45cm(3) (p<0.001) and PTV(boost) from 277 to 220cm(3) (p<0.001). The volume receiving more than 95% of the boost dose (V(95%(total-dose))) could be reduced by 19% (linear fit, R(2)=0.73) from on average 360 to 292cm(3) (p<0.001). Delay in treatment and the use of a prolonged treatment schedule with different fractionation for patients with seroma could thus be prevented.

CONCLUSION:

The adaptive radiation therapy IMRT-SIB procedure has proven to be efficient and effective, leading to a clinically significant reduction of the high dose volume. Seroma present in a subgroup of patients referred for breast radiation therapy does not hamper the introduction of highly conformal IMRT-SIB techniques

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