방사선 치료시 산란성 등의 피부영향을 피할 수 없으며 내부의 정상장기의 피폭은 피할 수 없다. 방사선 치료의 역사는 정상조직의 흡수선량 감소를 위한 역사라고 해도 과언이 아니다. 특히, 왼쪽 유방암의 방사선 치료시 내부 인접 장기로는 정상유방조직, 심장과 폐를 대표로 들 수 있는데 심장에 발생할 수 있는 부작용은 심정지, 심근경색 등이 있다. 본 논문에서는 왼쪽 유방암 환자의 방사선 치료시 호흡조절기법을 사용한 것과 일반 방사선치료계획을 시행하는 것 사이에 심장의 체적과 선량의 변화를 관찰하여 호흡으로 인해 발생하는 심장의 체적과 선량을 알아보았다. 연구결과 4차원 컴퓨터 단층촬영영상을 기준으로 심장의 체적은 평균 $12.8{\pm}8.7cc$의 차이가 나타났으며 이에 대해 선량은 평균 $17.3{\pm}12.1cGy$의 차이를 보였다. 이러한 체적과 선량의 차이는 향후 방사선 치료시 부작용을 발생시킬 수 있는 우려가 있으므로 호흡조절기법을 활용하여 심장의 정확한 위치를 기반으로 방사선 치료계획을 수립하여야 할 것이다.
방사선 치료시 산란성 등의 피부영향을 피할 수 없으며 내부의 정상장기의 피폭은 피할 수 없다. 방사선 치료의 역사는 정상조직의 흡수선량 감소를 위한 역사라고 해도 과언이 아니다. 특히, 왼쪽 유방암의 방사선 치료시 내부 인접 장기로는 정상유방조직, 심장과 폐를 대표로 들 수 있는데 심장에 발생할 수 있는 부작용은 심정지, 심근경색 등이 있다. 본 논문에서는 왼쪽 유방암 환자의 방사선 치료시 호흡조절기법을 사용한 것과 일반 방사선치료계획을 시행하는 것 사이에 심장의 체적과 선량의 변화를 관찰하여 호흡으로 인해 발생하는 심장의 체적과 선량을 알아보았다. 연구결과 4차원 컴퓨터 단층촬영영상을 기준으로 심장의 체적은 평균 $12.8{\pm}8.7cc$의 차이가 나타났으며 이에 대해 선량은 평균 $17.3{\pm}12.1cGy$의 차이를 보였다. 이러한 체적과 선량의 차이는 향후 방사선 치료시 부작용을 발생시킬 수 있는 우려가 있으므로 호흡조절기법을 활용하여 심장의 정확한 위치를 기반으로 방사선 치료계획을 수립하여야 할 것이다.
In radiation treatment, it is unavoidable to block the influence of scattered ray on a skin and prevent internal normal organs from being exposed to radiation. It is fair to say that radiation therapy aims to reduce an absorbed dose of normal tissues. In particular, in radiation therapy of left-side...
In radiation treatment, it is unavoidable to block the influence of scattered ray on a skin and prevent internal normal organs from being exposed to radiation. It is fair to say that radiation therapy aims to reduce an absorbed dose of normal tissues. In particular, in radiation therapy of left-sided breast cancer, the internal neighboring organs are normal breast tissues, the heart, and the lung. The side effects on the heart include cardioplegy and myocardial infarction. This study tried to observe changes in the volume and dose of the heart in general radiation therapy plan and respiratory control based radiation therapy plan for patients with left-sided breast cancer, and to find the heart's volume and dose generated by respiration. According to the 4D computer tomography (CT), a volume of the heart had $12.8{\pm}8.7cc$ on average, and its dose had $17.3{\pm}12.1cGy$ on average. The differences in the volume and dose may cause side effects in radiation treatment. Therefore, it is necessary to apply respiratory control technique to establish the radiation treatment plan based on an accurate position of the heart.
In radiation treatment, it is unavoidable to block the influence of scattered ray on a skin and prevent internal normal organs from being exposed to radiation. It is fair to say that radiation therapy aims to reduce an absorbed dose of normal tissues. In particular, in radiation therapy of left-sided breast cancer, the internal neighboring organs are normal breast tissues, the heart, and the lung. The side effects on the heart include cardioplegy and myocardial infarction. This study tried to observe changes in the volume and dose of the heart in general radiation therapy plan and respiratory control based radiation therapy plan for patients with left-sided breast cancer, and to find the heart's volume and dose generated by respiration. According to the 4D computer tomography (CT), a volume of the heart had $12.8{\pm}8.7cc$ on average, and its dose had $17.3{\pm}12.1cGy$ on average. The differences in the volume and dose may cause side effects in radiation treatment. Therefore, it is necessary to apply respiratory control technique to establish the radiation treatment plan based on an accurate position of the heart.
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제안 방법
In this study, a radiation treatment plan including heart move in gating was established. In radiation treatment, irradiation occurs for a certain time.
As an image acquisition method, 3 mm Slice Thickness was used. The region of treatment were determined by a medical doctor, and the 2 mm region was extended on the basis of GTV and then set as PTV.
Therefore, this study tried to observe changes in the volume and absorbed dose of the heart depending on respiration and organ move when left-sided breast cancer is treated and thereby to minimize the side effects of the heart in radiation treatment.
대상 데이터
The subjects of this study were 43 patients who were diagnosed with left-sided breast cancer, fully understood the purpose and method of this research, and agreed on participation. As shown in Table 1, the study subjects had their characteristics as follows: in terms of age, 7 patients were in their 30s, 8 in their 40s, and 5 in their 50s; in terms of stage, 9 patients were in stage 1, 9 in stage 2, and 2 in stage 3; in terms of therapy technique, 20 patients had partial mastectomy and all patients had breast tissues left.
이론/모형
As a tester, Sensation open CT of SIEMENS was used for simulation. As an image acquisition method, 3 mm Slice Thickness was used. The region of treatment were determined by a medical doctor, and the 2 mm region was extended on the basis of GTV and then set as PTV.
참고문헌 (18)
ICRU, International Commission on Radiation Units and Measurements. Report 62: Prescribing, Recording and Reporting Photon Beam Therapy (Supplement to ICRU Report 50), 1999
Brenner D: Induced cancers after prostate-cancer radiotherapy: No cause for concern? Journals of Radiation Oncology Biology Physics, Vol. 65, pp. 637-639, 2006
R. Wagman, E. Yorke, E. Ford, P. Giraud, G. Mageras, B. Minsky, and K. Rosenzweig: Respiratory gating for liver tumors: use in dose escalation, Journals of Radiation Oncology Biology Physics, Vol. 55, No. 3, pp. 659-668, 2003.
P. J. Keall, G. S. Mageras, J. M. Balter, R. S. Emery, K. M. Forster, and S. B. Jiang: The management of respiratory motion in radiation oncology report of AAPM Task Group 76, Medical Physics, Vol. 33, No. 10, pp. 3874-3901, 2006.
Jin JY, Ajlouni M, Chen Q: Quantification of incidental dose to potential clinical target volume (CTV) under different stereostactic body radiation therapy (SBRT) techniques for non-small cell lung cancer-tumormotion and using internal target volume (ITV) could improve dose distribution in CTV. Journals of Radiation Oncolog, Vol. 85, pp. 267-276, 2007
L. F. Paszat, W. J. Mackillop, P. A.Groome: Mortality from myocardial infarction after adjuvant radiotherapy for breast cancer in the surveillance, epidemiology, and end-results cancer registries, Journals of Clinical Oncology, Vol. 16, No. 8, pp. 2625-2631, 1998.
F. Lohr, F. Heggemann, T. and Papavassiliu: Is cardiotoxicity still an issue after breast -conserving surgery and could it be reduced by multifield IMRT?, Strahlentherapie und Onkologie, Vol. 185, No. 4, pp. 222-230, 2009.
Fulvio Orzan, Antonoio Brusca, Maria R Conte, Patrizia Presbirero, Maria C Figliomeni: Severe coronary artery disease after radiation therapy of the chest and mediastinum, Clinical presentation and treatment. Br Heart J, Vol. 69, pp. 496-500, 1993.
Ho choon Park, Young jae Kim, Seong joo Jang: The Usability Evaluation Half Beam Radiation Treatment Technique on the Esophageal Cancer, The Korean Society of Radiology, Vol. 9, No. 5, 2015.
Joong Sun Bin, Jae Myung Lee, Byung Dong Cho, Won Seok Choo, Sang Gyu Choi, Jung Bae Park, Young Cheoul Doo, Kyung Pyo Hong, Jong Yoon Im, Do Hoon Oh, Hoon Sik Bae: Acute Myocardial Infarction after Radiation Therapy for Left Sided Breast Cancer, The Korean Society of Circulation, Vol. 25, No. 1, pp. 114-118, 1995.
Y. J. Kim, Y. I. Jang, Y. S. Ji: Evaluation on Usefulness of Applying Body-fix to Four Dimensional Radiation Therapy, The Journal of the Korea Contents Association, Vol. 13, No. 10, pp. 419-426, 2013.
Hye-Jin Ko, Young-Jae Kim, Seong-Joo Jang: The Comparison of Dose Distribution on Radiation Therapy between IMRT and VMAT in Modified Radical Mastectomy Patients, The Journal of the Korea Contents Associationn, Vol. 14, No. 8, pp. 226-232, 2014.
Solin LJ, Chu JC, Sontag MR: Three-dimensional photon treatment planning of the intact breast. Journals of Radiation Oncology Biology Physics, Vol. 21, pp. 193-203, 1991.
Chin LM, Cheng CW, Siddon RL: Three-dimensional photon dose distributions with and without lung corrections for tangential breast intact treatments. Journals of Radiation Oncology Biology Physics, Vol. 17, pp. 1327-1335, 1989.
Fraass BA, Lichter AS, McShan DL: The influence of lung density corrections on treatment planning for primary breast cancer. Journals of Radiation Oncology Biology Physics Vol. 14, pp. 179-190, 1988.
Evans PM, Hansen VN, Mayles WP: Design of compensators for breast radiotherapy using electronic portal imaging. Journals of Radiation Oncology Biology Physics, Vol. 37, pp. 43-54, 1995.
Hong L, Hunt M, Chui C: Intensity-modulated tangential beam irradiation of the intact breast, Journals of Radiation Oncolgy Biology Physics, Vol. 44, pp. 1155-1164, 1999.
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