[논문]유방암 환자의 방사선치료에 있어서 순치료계획 세기변조방사선치료법과 쐐기접선조사기법의 선량측정 비교

김수지; 최윤석

doi:10.14316/pmp.2014.25.4.199

유방암 환자의 방사선치료에 있어서 순치료계획 세기변조방사선치료법과 쐐기접선조사기법의 선량측정 비교
Dosimetric Advantages of the Field-in-field Plan Compared with the Tangential Wedged Beams Plan for Whole-breast Irradiation 원문보기

Progress in Medical Physics = 의학물리, v.25 no.4, 2014년, pp.199 - 204

김수지 (서울대학교 보라매병원 방사선종양학과) , 최윤석 (서울대학교 보라매병원 방사선종양학과)

초록
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유방암 환자들에 대한 방사선치료에서 순치료계획 세기변조방사선치료법을 쐐기접선조사기법과 선량측정면에서 비교분석하고자 이 연구를 수행했다. 우측 유방암 환자 20명과 좌측 유방암 환자 10명에 대해 후향적으로 연구를 시행했다. 각 환자에 대해 쐐기접선조사기법과 순치료계획 세기변조방사선치료법을 이용한 방사선치료 계획을 수립한 후에 선량학적 분석을 시도했다. 방사선치료계획용 표적체적에 대한 선량학적 비교 분석을 위해 homogeneity index, conformity index, uniformity index를 사용했다. 또한 폐와 심장에 대한 선량학적 분석을 위해서 평균선량값과 10, 20, 30 Gy 이상을 조사받는 체적의 백분율을 비교했다. 순치료계획 세기변조방사선치료법은 쐐기접선조사기법에 비해 계획표적체적에 대해 선량측정면에서 통계적으로 의미있게 더 나은 결과를 보였다. 폐에 대한 방사선량도 순치료계획 세기변조방사선치료법을 사용했을 때 10 Gy, 30 Gy 이상 조사받는 체적의 백분율이 통계적으로 의미있게 낮았다. 좌측 유방암 환자들에서 심장에 대한 방사선량을 측정했을 때에도 순치료계획 세기변조방사선치료법을 사용했을 때 평균선량값, 20 Gy, 30 Gy이상 조사받는 체적의 백분율이 더 낮은 것을 알 수 있었다. 순치료계획 세기변조방사선치료법은 쐐기접선조사기법에 비해 유방의 표적체적에 대한 선량균일성, 적합성 등에서 더 나은 결과를 보였다. 또한 순치료계획 세기변조방사선치료법을 사용했을 때 폐와 심장에 대한 방사선량도 더 낮출 수 있었다.

Abstract ▼ AI-Helper

The purpose of this study is to evaluate the dosimetric outcome of the field-in-field (FIF) plans compared with tangential wedged beams (TWB) plans for whole breast irradiation of breast cancer patients. Twenty patients with right-sided breast cancer and 10 patients with left-sided breast cancer were retrospectively enrolled in this study. We generated a FIF plan and a TWB plan for each patient to compare dosimetric outcomes. The dose the homogeneity index (HI), the conformity index (CI) and the uniformity index (UI) were defined and used for comparison of the dosimetric outcome of the planning target volume (PTV). To compare the dosimetric outcome of the organs at risk, the mean dose ($D_{mean}$) and the percentage of volumes receiving more than 10, 20 and 30 Gy of the ipsilateral lung and heart were used. The FIF plans had significantly lower HI (p=0.002), higher UI (p=0.000) and CI (p=0.000) than those of the TWB plans, which means that the FIF plans were better than the TWB plans in the dosimetric comparisons of the PTV. The $V10_{lung}$ ($17.1{\pm}7.1$ vs. $18.6{\pm}6.6%$, p=0.020) and $V30_{lung}$ ($10.3{\pm}5.1%$ vs. $10.7{\pm}5.2%$, p=0.000) were lower with the FIF plans compared with those of the TWB plans, with statistical significance. For the left-sided breast cancer patients, $D_{mean}$ of the heart ($2.6{\pm}1.3$ vs. $3.2{\pm}1.4$ Gy, p=0.000), $V20_{heart}$ ($3.4{\pm}2.6$ vs. $3.6{\pm}2.8%$, p=0.005) and $V30_{heart}$ ($2.6{\pm}2.3%$ vs. $2.9{\pm}2.4%$, p=0.004) were significantly lower for the FIF plans in comparison with those of the TWB plans. The FIF plans increased the dose homogeneity, conformity and uniformity of the target volume for the whole-breast irradiation compared with the TWB plans. Moreover, FIF plans reduced the doses to the ipsilateral lung and heart.

주제어

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문제 정의

This study was carried out to evaluate the dosimetric outcome of the FIF plans compared to TWB plans and to confirm the advantages of the FIF plans.

제안 방법

The consecutive 20 patients with right-sided breast cancer and 10 patients with left-sided breast cancer, who were treated in our department between March 2012 and March 2013, were included in this analysis retrospectively. All patients had undergone BCS and were treated with postoperative RT, in which 50.4 Gy in 28 fractions were delivered to the whole breast using the FIF technique.
All patients underwent CT simulation. Patients were immobilized on the Breastboard (Civco, Orange City, IA, USA) and skin wires were placed on the medial and lateral borders.
For each patient, the TWB plan and FIF plan were generated on a treatment planning system. Two plans for each patient used the same isocenter, tangential beam angles, and collimator sizes.
The UI was defined as the percentage of PTV volume included in the interval 97% to 103% of the prescribed dose and used to evaluate the PTV dose improvement.
This was done by sequentially blocking the hot dose areas with 3∼5% increments in the beam’s eye projections of the treatment field.

대상 데이터

All patients underwent CT simulation. Patients were immobilized on the Breastboard (Civco, Orange City, IA, USA) and skin wires were placed on the medial and lateral borders. The medial border was set at the midline of the chest, and the lateral border was defined by physical examination.
The consecutive 20 patients with right-sided breast cancer and 10 patients with left-sided breast cancer, who were treated in our department between March 2012 and March 2013, were included in this analysis retrospectively. All patients had undergone BCS and were treated with postoperative RT, in which 50.

데이터처리

For comparison of mean values of the indices of the two different treatment plans, the paired t-test was used. A p-value of less than 0.

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용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

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