Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients

DEMİRCİOĞLU, Fatih; KILIC, Diclehan; İREN, Sevilay; ÇATLI DİNÇ, SERAP

Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients

SERAP ÇATLI DİNÇ, (Gazi Üniversitesi, Tıp Fakültesi, Radyasyon Onkoloji Anabilim Dalı, Ankara, Türkiye)

Fatih DEMİRCİOĞLU, (Recep Tayyip Erdoğan Üniversitesi, Rize Eğitim Araştırma Hastanesi, Radyasyon Onkolojisi Anabilim Dalı, Rize, Türkiye)

Diclehan KILIÇ, (Gazi Üniversitesi, Tıp Fakültesi, Radyasyon Onkoloji Anabilim Dalı, Ankara, Türkiye)

Sevilay İREN (Manisa Devlet Hastanesi, Radyasyon Onkolojisi Kliniği, Manisa, Türkiye)

Meme Sağlığı Dergisi

2 1

Yıl: 2013 Cilt: 9 Sayı: 4 Sayfa Aralığı: 205 - 209 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients

Öz:

Amaç: Çalışmada meme kanseri ışınlamasında geleneksel arka aksilla alanını içeren plan dozimetrisi, bilgisayarlı tomografide (BT) hedef hac-min belirlenerek yapıldığı ön aksilla alanını içeren plan dozimetrisi ilekarşılaştırılmıştır. Yöntem ve Gereçler: Yirmi altı meme kanserli olgu çalışmaya seçilmiştir. Hedef hacimler 2 öğretim görevlisi tarafından konturlanmıştır. Arka aksilla planında geleneksel anatomik yapılar baz alınarak posterior alan oluşturulmuştur. Ön aksilla alanının bulunduğu planda supraklavikuler (SK) bölge ile aynı gantri açısında ikinci bir ön alan oluşturulmuştur. V105 (%105 ve üzerinde doz alan hacim), V80 ve V30 değerleri, akciğer ortalama dozu, akciğer V20 (20 Gy ve üzerinde doz alan hacim) değeri, maksimum spinal kord dozu, konformite indeksi ve monitör ünit (MU) değerleri belirlenmiştir. İki bağımsız grubun kıyaslanmasında Mann-Whitney U testi, 2 bağımlı grubun kıyaslamasında Wilcoxon’s signed rank testi kullanılmıştır. p<0,05 değeri anlamlı olarak kabul edilmiştir. Bulgular: Ön aksilla planında daha küçük sıcak nokta alanları ve daha konformal %90 izodoz eğrisi saptandı. Arka aksilla planında düşük doz tedavi alanı daha geniş saptandı. Ortalama V105 değeri; ön aksilla planında istatiksel anlamlı daha düşük (70,8’e karşı 52,8, p=0,005) ve hedef hacim derinliği ile korele olarak saptandı. Orta (V80) ve düşük doz (V30) alan hacimler (sırasıyla p=0,005 ve p=0,009), ortalama akciğer dozu (p=0,04) ve akciğer V20 değeri (p=0,03) ön aksilla planında istatiksel anlamlı daha düşük saptandı. Maksimum spinal kord dozu açısından iki teknik arasında fark saptanmadı. Konformite indeksi ön aksilla planında anlamlı daha yüksek saptandı (0,023’e karşı 0,025, p=0,005). Arka aksilla planı ile hastanın tedavi süresinin daha uzun olduğu bulundu (242,3 MU, p=0,047). Sonuç: Ön aksilla alanını içeren plan, Türk hastaların anatomisinde geleneksel metoda kıyasla üstün bulunmuştur. Hedef hacimlerin belirlenerek, doz optimizasyonuyla yapılacak BT tedavi planlaması SK ve aksiller lenf nodu tedavisinde standart olmalıdır. Farklı teknikler dozimetrik ve klinik üstünlük açısından kıyaslamalı olarak irdelenmelidir.

Anahtar Kelime:

Konular: Cerrahi

Meme kanserli olgularda adjuvan bölgesel lenf nodu ışınlamasında aksiller boost tekniği

Öz:

Objective: In this study, the posterior and anterior axillary field dosimetries,where the target volume was determined on computerised tomography (CT),were compared in breast cancer irradiation.Materials and Methods: Twenty-six breast cancer patients were examined in this study. Target volumes were contoured by 2 physicians. The posterior field was established by traditional anatomical structures in the posterior axillary plan (PAP). The second anterior field was performed in the same gantry angle with Supraclacicular field (SCF) at the anterior axillary plan (AAP). V105 (volume receiving ≥105% prescribed dose), V80 ve V30 values, mean lung dose, V20 (lung volume receiving ≥20 Gy) value, maximum spinal cord dose, conformity index and monitor unit (MU) values were defined. Two independent groups were compared with Mann-Whitney U test, 2 dependent groups were compared with Wilcoxon’s signed rank test. p<0.05 was considered as statistically significant. Results: Small hot-point areas defined as volumes receiving more than 105% of the prescribed dose and more conformal 90% isodose curves were established at AAP. Low-dose areas were wider at PAP. Mean V105 (70.8 to 52.8, p=0.005), V80 and V30 volumes (p=0.005 and p=0.009 respec- tively), mean lung dose (p=0.04) and V20 value (p=0.03) were statistically significantly lower at AAP. There was no difference between two groups as maximum spinal cord dose. Conformity index was significantly higher at AAP (0.023 to 0.025, p=0.005). Treatment time was found longer at PAP (242.3 MU, p=0.047). Conclusion: According to the anatomy of the Turkish patients, AAP was superior when compared to the traditional method. The CT based treatment planning with dose optimization and target volume determination must be the standard treatment of SCF and axillary lymph node. Different techniques should be studied comparatively in terms of dosimetric and clinical superiority.

Anahtar Kelime:

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy: Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997; 337: 949-55. (PMID: 9395428)
2. Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast- cancer patients given adjuvant tamoxifen: Danish Breast Cancer Coope- rative Group DBCG 82c randomised trial. Lancet 1999; 353: 1641-8. (PMID: 10335782)
3. Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML. Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol 2000; 18: 1220-9. (PMID: 10715291)
4. Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, Basco VE, et al. Adjuvant radiotherapy and chemotherapy in node-positive preme- nopausal women with breast cancer. N Engl J Med 1997; 337: 956-62. (PMID: 9309100)
5. Bentel GC, Marks LB, Hardenbergh PH, Prosnitz LR. Variability of the depth of supraclavicular and axillary lymph nodes in patients with breast cancer: Is a posterior axillary boost field necessary? Int J Radiat Oncol Biol Phys 2000; 47: 755-8. (PMID: 10837961)
6. Klages HT, Szafinski F, Makoski HB. Variation in ‘’supraclavicular’’ lymph node depth is partly determined by treatment position. Strahlent- her Onkol 2000; 176: 315-8. (PMID: 10962997)
7. Madu CN, Quint DJ, Normolle DP, Marsh RB, Wang EY, Pierce LJ. Definition of the supraclavicular and infraclavicular nodes: Implications for three-dimensional CT-based conformal radiation therapy. Radiology 2001; 221: 333-9. (PMID: 11687672)
8. Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Fine RE, et al. Postmastectomy radiotherapy: Clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001; 19: 1539-69. (PMID: 11230499)
9. Smith JA, Gamez-Araujo JJ, Gallager HS, White EC, McBride CM. Carcinoma of the breast: analysis of total lymph node involvement versus level of metastasis. Cancer 1977; 39: 527-32. (PMID: 837335)
10. White J, Tai A, Arthur D, Buchholz T, MacDonald S, Marks L, et al. RTOG Breast Cancer Contouring Atlas. http://www.rtog.org/CoreLab/ ContouringAtlases/BreastCancerAtlas.aspx. Accessed July 29, 2012.
11. Goodman RL, Grann A, Saracco P, Needham MF. The relationship between radiation fields and regional lymph nodes in carcinoma of the breast. Int J Radiat Oncol Biol Phys 2001; 50: 99-105. (PMID: 11316551)
12. Cavey ML, Bayouth JE, Endres EJ, Pena JM, Colman M, Hatch S. Dosimetric comparison of conventional and forward-planned intensity-modulated techniques for comprehensive locoregional irradiation of post-mastectomy left breast cancers. Med Dosim 2005; 30: 107-16. (PMID: 15922178)
13. Krueger EA, Fraass BA, McShan DL, Marsh R, Pierce LJ. Potential gains for irradiation of chest wall and regional nodes with intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2003; 56: 1023-37. (PMID: 12829138)
14. Jephcott CR, Tyldesley S, Swift CL. Regional radiotherapy to axilla and supraclavicular fossa for adjuvant breast treatment: a comparison of four techniques. Int J Radiat Oncol Biol Phys 2004; 60: 103-10. (PMID: 15337545)
15. Wang X, Yu TK, Salehpour M, Zhang SX, Sun TL, Buchholz TA. Breast cancer regional radiation fields for supraclavicular and axillary lymph node treatment: is a posterior axillary boost field technique optimal? Int J Radiat Oncol Biol Phys 2009; 74: 86-91. (PMID: 18805650)
16. Sethi RA, No HS, Jozsef G, Ko JP, Formenti SC. Comparison of three- dimensional versus intensity-modulated radiotherapy techniques to treat breast and axillary level III and supraclavicular nodes in a prone versus supine position. Radiother Oncol 2012; 102: 74-81. (PMID: 21993404)

APA	ÇATLI DİNÇ S, DEMİRCİOĞLU F, KILIC D, İREN S (2013). Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients. , 205 - 209.
Chicago	ÇATLI DİNÇ SERAP,DEMİRCİOĞLU Fatih,KILIC Diclehan,İREN Sevilay Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients. (2013): 205 - 209.
MLA	ÇATLI DİNÇ SERAP,DEMİRCİOĞLU Fatih,KILIC Diclehan,İREN Sevilay Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients. , 2013, ss.205 - 209.
AMA	ÇATLI DİNÇ S,DEMİRCİOĞLU F,KILIC D,İREN S Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients. . 2013; 205 - 209.
Vancouver	ÇATLI DİNÇ S,DEMİRCİOĞLU F,KILIC D,İREN S Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients. . 2013; 205 - 209.
IEEE	ÇATLI DİNÇ S,DEMİRCİOĞLU F,KILIC D,İREN S "Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients." , ss.205 - 209, 2013.
ISNAD	ÇATLI DİNÇ, SERAP vd. "Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients". (2013), 205-209.

APA	ÇATLI DİNÇ S, DEMİRCİOĞLU F, KILIC D, İREN S (2013). Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients. Meme Sağlığı Dergisi, 9(4), 205 - 209.
Chicago	ÇATLI DİNÇ SERAP,DEMİRCİOĞLU Fatih,KILIC Diclehan,İREN Sevilay Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients. Meme Sağlığı Dergisi 9, no.4 (2013): 205 - 209.
MLA	ÇATLI DİNÇ SERAP,DEMİRCİOĞLU Fatih,KILIC Diclehan,İREN Sevilay Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients. Meme Sağlığı Dergisi, vol.9, no.4, 2013, ss.205 - 209.
AMA	ÇATLI DİNÇ S,DEMİRCİOĞLU F,KILIC D,İREN S Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients. Meme Sağlığı Dergisi. 2013; 9(4): 205 - 209.
Vancouver	ÇATLI DİNÇ S,DEMİRCİOĞLU F,KILIC D,İREN S Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients. Meme Sağlığı Dergisi. 2013; 9(4): 205 - 209.
IEEE	ÇATLI DİNÇ S,DEMİRCİOĞLU F,KILIC D,İREN S "Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients." Meme Sağlığı Dergisi, 9, ss.205 - 209, 2013.
ISNAD	ÇATLI DİNÇ, SERAP vd. "Axillary boost technique on adjuvant regional lymph node irradiation in breast cancer patients". Meme Sağlığı Dergisi 9/4 (2013), 205-209.