仰卧位和俯卧位六种全乳照射技术的剂量分析-动脉网

Dosimetric analysis of six whole-breast irradiation techniques in supine and prone positions

Nature 等信源发布 2024-06-21 00:58

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AbstractIn breast cancer radiation therapy, minimizing radiation-related risks and toxicity is vital for improving life expectancy. Tailoring radiotherapy techniques and treatment positions can reduce radiation doses to normal organs and mitigate treatment-related toxicity. This study entailed a dosimetric comparison of six different external beam whole-breast irradiation techniques in both supine and prone positions.

摘要在乳腺癌放射治疗中，最大程度地减少与辐射相关的风险和毒性对于提高预期寿命至关重要。定制放射治疗技术和治疗位置可以减少对正常器官的辐射剂量并减轻与治疗相关的毒性。这项研究需要在仰卧位和俯卧位对六种不同的外照射全乳照射技术进行剂量学比较。

We selected fourteen breast cancer patients, generating six treatment plans in both positions per patient. We assessed target coverage and organs at risk (OAR) doses to evaluate the impact of treatment techniques and positions. Excess absolute risk was calculated to estimate potential secondary cancer risk in the contralateral breast, ipsilateral lung, and contralateral lung.

我们选择了14名乳腺癌患者，每位患者在两个位置都产生了六个治疗计划。我们评估了目标覆盖率和风险器官（OAR）剂量，以评估治疗技术和位置的影响。计算超额绝对风险以估计对侧乳房，同侧肺和对侧肺中潜在的继发性癌症风险。

Additionally, we analyzed the distance between the target volume and OARs (heart and ipsilateral lung) while considering the treatment position. The results indicate that prone positioning lowers lung exposure in X-ray radiotherapy. However, particle beam therapies (PBTs) significantly reduce the dose to the heart and ipsilateral lung regardless of the patient’s position.

此外，我们在考虑治疗位置的同时分析了目标体积与OAR（心脏和同侧肺）之间的距离。结果表明，俯卧位可降低X射线放射治疗中的肺部暴露。然而，无论患者的位置如何，粒子束疗法（PBT）都会显着降低心脏和同侧肺的剂量。

Notably, negligible differences were observed between arc-delivery and static-delivery PBTs in terms of target conformity and OAR sparing. This study provides critical dosimetric evidence to facilitate informed decision-making regarding treatment techniques and positions..

值得注意的是，在目标一致性和OAR保留方面，电弧输送和静态输送PBT之间的差异可以忽略不计。本研究提供了关键的剂量学证据，以促进有关治疗技术和位置的知情决策。。

IntroductionBreast cancer is the most frequently diagnosed malignancy and a leading cause of mortality among women1,2. Modern multidisciplinary treatment strategies, encompassing surgical resection, postoperative radiation, and preoperative or postoperative systemic therapy, have significantly enhanced the long-term survival prospects of breast cancer patients3.

引言乳腺癌是最常被诊断出的恶性肿瘤，也是女性死亡的主要原因1,2。包括手术切除，术后放疗以及术前或术后全身治疗在内的现代多学科治疗策略显着提高了乳腺癌患者的长期生存前景3。

Notably, radiation therapy following breast-conserving surgery has exhibited outcomes on par with mastectomy4,5, especially for early-stage cases; this has led to an increased emphasis on improving patients’ long-term quality of life while minimizing radiation-induced malignancy.The primary side effects of concern in breast cancer radiotherapy patients are radiogenic heart and lung damage6,7,8,9,10,11.

值得注意的是，保乳手术后的放射治疗显示出与乳房切除术相当的结果4,5，特别是对于早期病例；。乳腺癌放疗患者关注的主要副作用是放射性心脏和肺部损伤6,7,8,9,10,11。

A study by Darby et al. reported a linear increase of 7.4% per Gray (Gy) in the rate of major coronary events concerning the mean heart dose7. Furthermore, the reduction of the dose on the left anterior descending (LAD) artery has been shown to decrease the risk of radiation-induced stenosis in the heart12.

Darby等人的一项研究报道，与平均心脏剂量有关的主要冠状动脉事件发生率每灰色（Gy）线性增加7.4%。此外，左前降支（LAD）动脉剂量的减少已被证明可以降低心脏放射性狭窄的风险12。

Research has revealed that specific regions of the heart, including the heart apex or portions of the LAD artery, may receive high doses (up to 47.2 Gy) despite a low mean heart dose (below 3 Gy)13. Additionally, the risk of secondary cancer, often arising from irradiation of the contralateral breast or lungs, is a critical consideration14,15.

研究表明，尽管平均心脏剂量较低（低于3 Gy），但心脏的特定区域，包括心尖或LAD动脉的部分，可能会接受高剂量（高达47.2 Gy）13。。

For patients who survive beyond five years, breast cancer radiation therapy has been associated with a 14% increase in contralateral breast cancer risk, with younger patients and longer latency periods posing a higher risk15,16,17.The clinical application of breast cancer radiation therapy has evolved from early three-dimensional conformal radiation therapy (3DCRT) to mor.

对于存活超过五年的患者，乳腺癌放射治疗与对侧乳腺癌风险增加14%相关，年轻患者和更长的潜伏期会带来更高的风险15,16,17。乳腺癌放射治疗的临床应用已经从早期三维适形放射治疗（3DCRT）发展到mor。

(1)

where OED is the organ equivalent dose, β` represents the initial slope of the dose–response curve relationship of secondary cancer induction, agea is the attained age from the exposed age agex, and γe and γa denote age-modifying factors. All parameters utilized for calculating Excess Absolute Risks (EARs) were sourced from Schneider's work42.

其中OED是器官等效剂量，β'表示继发性癌症诱导的剂量-反应曲线关系的初始斜率，agea是从暴露年龄agex到的年龄，γe和γa表示年龄修饰因子。用于计算超额绝对风险（EAR）的所有参数均来自施耐德的工作42。

The initial computation of EARs was conducted for patients based on their actual ages of irradiation, under the presumption that they would live to be 70 years old. To mitigate the influence of varying irradiation ages on EAR findings, a standardization process was implemented by recalculating EARs for a specific cohort.

根据患者的实际照射年龄，在假设他们将活到70岁的情况下，对患者的耳朵进行了初步计算。为了减轻不同照射年龄对耳朵发现的影响，通过重新计算特定队列的耳朵来实施标准化过程。

This cohort consisted of individuals irradiated at the age of 30, with projections indicating they would achieve an age of 70. This adjustment allows for a more consistent comparison of EARs across different patient groups.Organ equivalent dose (OED) was used to calculate EAR, utilizing a plateau dose–response model for estimating the OED of the contralateral breast as follows:$${OED}_{plateau}= \frac{1}{V}\sum_{i}{V}_{i}(\frac{1-\text{exp}(-\delta {D}_{i})}{\updelta })$$.

该队列由30岁时接受照射的个体组成，预测表明他们将达到70岁。这种调整允许对不同患者组的耳朵进行更一致的比较。器官等效剂量（OED）用于计算EAR，利用高原剂量反应模型估算对侧乳房的OED，如下所示：$${OED}_{平台}=\frac{1}{V}\sum\ui}{V}_{i} （\frac{1-\text{exp}（-\delta{D}_{i} ）}{\updelta}）$$。

(2)

Upon the refinement of the plateau model, coupled with the consideration of the number of fractions in fractionated therapy, the OED for an organ, as per the full mechanistic model, was determined as follows:$${OED}_{mechanistic}= \frac{1}{V}\sum_{i}{V}_{i}\left(\frac{1-\text{exp}\left(-\delta {D}_{i}\right)}{\delta \text{R}}\right)[ 1-2R+ {R}^{2}\text{exp}\left(-\delta {D}_{i}\right)- {\left(1-R\right)}^{2}\text{exp}(-{\frac{\delta \text{R}}{1-R}D}_{i}) ]$$.

在改进平台模型后，再加上考虑分次治疗中的分数数量，根据完整的力学模型，器官的OED确定如下：$${OED}_{机械}=\frac{1}{V}\sum\ui}{V}_{i} 左（\frac{1-\text{exp}\left（-\delta{D}_{i} 右）}{\delta\text{R}}\right）[1-2R+{R}^{2}\text{exp}\left（-\delta{D}_{i} \右）-{\左（1-R \右）}^{2}\文本{exp}（-{\ frac{\ delta \ text{R}}{1-R}D}_{i} ）]$$。

(3)

where V represents the total volume of the organ at risk (including contralateral breast, ipsilateral lung, and contralateral lung) and Vi denotes a specific volume element that is subjected to an exposed dose element Di42,43. For the full mechanistic model, the parameter δ was determined to be 0.044 Gy−1 with R equaling 0.15 for the female breast, and δ is 0.042 Gy−1 with R set at 0.83 for the lung.

其中V表示风险器官（包括对侧乳房，同侧肺和对侧肺）的总体积，Vi表示受到暴露剂量元素Di42,43的特定体积元素。对于完整的机械模型，女性乳房的参数δ确定为0.044 Gy-1，R等于0.15，肺的参数δ为0.042 Gy-1，R设置为0.83。

These parameters were derived from a combined fit to the data from atomic bomb survivors and Hodgkin’s disease patients treated with single doses ranging from 2 to 40 Gy assuming an alpha/beta (α/β) value of 3 Gy.Statistical analysisTo compare the dosimetric parameters and geometric distances for these treatment plans, we conducted paired two-tailed t-tests, with Bonferroni correction applied (utilizing SPSS, v26, Chicago, USA).

假设α/β（α/β）值为3 Gy，这些参数是根据原子弹幸存者和接受2至40 Gy单剂量治疗的霍奇金病患者的数据得出的。统计分析为了比较这些治疗计划的剂量学参数和几何距离，我们进行了成对的双尾t检验，并应用了Bonferroni校正（利用SPSS，v26，美国芝加哥）。

The data were presented as mean values with standard deviations, and statistical significance was considered at p < 0.05.ResultsA total of 168 treatment plans from 14 patients were evaluated in this study. Figure 1 illustrates an example of axial CT images with dose distributions in the supine and prone positions of a patient for six treatment techniques.

数据以标准差的平均值表示，统计学显着性为p<0.05。结果本研究共评估了14例患者的168个治疗计划。图1显示了六种治疗技术在患者仰卧位和俯卧位剂量分布的轴向CT图像示例。

The dosimetric results of PTV and OARs for the treatment techniques are presented in Supplementary Table S1.Dosimetric comparison of treatment techniquesFigure 2 displays the mean target coverage and differences in OAR doses among 14 patients for the six techniques. VMAT exhibited superior PCI coverage, albeit it recorded the highest mean dose to the contralateral breast.

PTV和OAR治疗技术的剂量学结果见补充表S1。治疗技术的剂量学比较图2显示了这六种技术的14名患者的平均目标覆盖率和OAR剂量差异。VMAT表现出优异的PCI覆盖率，尽管它记录了对侧乳房的最高平均剂量。

Notably, statistically significant reductions in mean heart dose, mean lung dose, and mean contralateral breast dose were observed with PBT compared to XRT (p < 0.05). However, a proclivity toward higher skin dose .

。然而，倾向于更高的皮肤剂量。

Data availability

数据可用性

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

本研究中使用和/或分析的数据集可根据合理要求从通讯作者处获得。

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Download referencesAcknowledgementsThis work was supported by a faculty research grant of Yonsei University College of Medicine (6-2021-0234), by Korea Institute for Advancement of Technology (KIAT) Grant funded by the Korea Government (P0026103), by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (RS-2023-00249964), and by the Nuclear Safety Research Program (RS-2022-KN071210) through the Korea Foundation of Nuclear Safety (KOFONS) using the financial resource granted by the Nuclear Safety and Security Commission (NSSC) of the Republic of Korea.Author informationAuthors and AffiliationsDepartment of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, South Korea, 03722Dong Wook Kim, Chae-Seon Hong, Ye-In Park, Min Cheol Han, Hojin Kim & Jin Sung KimDepartment of Radiation Oncology, Yongin Severance Hospital, Yongin, South KoreaJunyoung SonDepartment of Radiation Oncology, Yonsei Cancer Center, Seoul, South KoreaSe Young KimDepartment of Radiation Oncology, Changwon Hanmaeum Hospital, Hanyang University College of Medicine, Changwon, South KoreaMijoo ChungDepartment of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, South KoreaWeon Kuu ChungDepartment of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South KoreaJihun KimAuthorsDong Wook KimView author publicationsYou can also search for this author in.

下载参考文献致谢这项工作得到了延世大学医学院院系研究资助（6-2021-0234），韩国政府资助的韩国技术进步研究所（KIAT）资助（P0026103），韩国教育部资助的韩国国家研究基金会（NRF）的基础科学研究计划（RS-2023-00249964）以及韩国核安全基金会（KOFONS）的核安全研究计划（RS-2022-KN071210）的支持，该计划使用了大韩民国核安全与保障委员会（NSSC）提供的财政资源。作者信息作者和附属机构延世大学医学院延世癌症中心放射肿瘤学系，延世大学医学院重离子治疗研究所，50-1，延世罗，Seodaemun Gu，韩国首尔，03722 Dong Wook Kim，Chae Seon Hong，Ye In Park，Min Cheol Han，Hojin Kim＆Jin Sung Kim韩国延世大学医学院延世Severance医院放射肿瘤学系Ijoo Chung韩国首尔江东庆熙大学医院放射肿瘤学系韩国首尔延世大学医学院江南遣散医院放射肿瘤学系KimAuthorsDong-Wook KimView作者出版物您也可以在中搜索这位作者。

PubMed Google ScholarChae-Seon HongView author publicationsYou can also search for this author in

PubMed Google ScholarChae Seon HongView作者出版物您也可以在

PubMed Google ScholarJunyoung SonView author publicationsYou can also search for this author in

PubMed Google ScholarJunyoung SonView作者出版物您也可以在

PubMed Google ScholarSe Young KimView author publicationsYou can also search for this author in

PubMed Google ScholarSe Young KimView作者出版物您也可以在

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PubMed Google ScholarJihun KimView author publicationsYou can also search for this author in

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PubMed Google ScholarContributionsConceptualization, D.W.K., C.-S.H., and J.S.K.; methodology, D.W.K., J.S., S.Y.K., and C.-S.H.; soft-ware, Y.I.P.; validation, D.W.K, J.S., S.Y.K., and C.-S.H.; formal analysis, D.W.K., and C.-S.H.; investigation, M.C. and W.K.C.; resources, M.C.

PubMed谷歌学术贡献概念化，D.W.K.，C.-S.H。和J.S.K。；。；软件，Y.I.P。；验证，D.W.K，J.S.，S.Y.K。和C.S.H。；形式分析，D.W.K。和C.S.H。；调查，M.C.和W.K.C。；资源，M.C。

and W.K.C.; data curation, M.C.H., J.K., and H.K.; writing—original draft preparation, D.W.K. and C.-S.H.; writing—review and editing, D.W.K. and C.-S.H.; visualization, Y.I.P. and C.-S.H.; supervision, D.W.K.; project administration, D.W.K., C.-S.H., and J.S.K.; funding acquisition, D.W.K. and C.-S.H.All authors have read and agreed to the published version of the manuscript.Corresponding authorsCorrespondence to.

和W.K.C。；。；撰写原稿准备，D.W.K.和C.-S.H。；写作评论和编辑，D.W.K.和C.-S.H。；可视化，Y.I.P.和C.S.H。；监督，D.W.K。；项目管理，D.W.K.，C.-S.H。和J.S.K。；资助获取，D.W.K.和C.-S.H.所有作者都阅读并同意稿件的发布版本。通讯作者通讯。

Chae-Seon Hong or Jin Sung Kim.Ethics declarations

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Reprints and permissionsAbout this articleCite this articleKim, D.W., Hong, CS., Son, J. et al. Dosimetric analysis of six whole-breast irradiation techniques in supine and prone positions.

转载和许可本文引用本文Kim，D.W.，Hong，CS。，。

Sci Rep 14, 14347 (2024). https://doi.org/10.1038/s41598-024-65461-yDownload citationReceived: 27 November 2023Accepted: 20 June 2024Published: 21 June 2024DOI: https://doi.org/10.1038/s41598-024-65461-yShare this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1414347（2024）。https://doi.org/10.1038/s41598-024-65461-yDownload引文接收日期：2023年11月27日接收日期：2024年6月20日发布日期：2024年6月21日OI：https://doi.org/10.1038/s41598-024-65461-yShare本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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