대한방사선치료학회지 (The Journal of Korean Society for Radiation Therapy)

  • 제33권
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  • Pages.137-144
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  • 2021
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  • 1598-8449(pISSN)
대한방사선치료학회 (Korean Society for Radiation Therapy)
권호 표지

쇄골 상부 림프절을 포함하는 왼쪽 유방암의 VMAT 치료계획시 X-Jaw split을 이용한 선량비교에 관한 연구

Study on dose comparison using X-Jaw split in VMAT treatment planning for left breast cancer including supraclavicular lymph nodes.

  • 김학준 (서울특별시 보라매병원 방사선종양학과) ;
  • 이양훈 (서울특별시 보라매병원 방사선종양학과) ;
  • 민제순 (서울특별시 보라매병원 방사선종양학과)
  • Kim, Hak Jun (Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center) ;
  • Lee, Yang Hoon (Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center) ;
  • Min, Jae Soon (Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center)
  • 발행 : 2021.12.31
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초록

목 적 : VMAT을 이용한 쇄골 상부 림프절을 포함하는 왼쪽 유방암 치료 시 X-Jaw를 나눈 치료계획과 기존 Full field VMAT 치료계획과의 선량분포를 비교 분석하여 X-Jaw split VMAT의 유용성을 평가하였다. 대상 및 방법 : 쇄골 상부 림프절을 포함하는 왼쪽 유방암 환자 10명을 대상으로 Vacuum cushion을 이용하여 CT simulation 하고 2 Arc Full field VMAT과 4 Arc X-Jaw split VMAT을 각각 치료계획 하였다. 각 치료계획은 처방 선량(Prescription dose)이 치료계획표적용적(Planning Target Volume, PTV)의 95% 이상 포함이 되고 주변 정상장기(Organ at risk, OAR)에 최소한으로 조사되도록 설계하였다. 이후 선량체적용적(Dose volume histogram, DVH)을 통해 PTV과 OAR의 대한 선량분석을 하였다. 결 과 : 10명의 환자의 Full field VMAT치료계획과 X-Jaw split VMAT치료계획의 데이터를 평균값으로 나타내어 비교하였다. 처방선량지수(conformity index, CI) 1.05±0.04, 1.04±0.03, 선량균질지수(homogeneity index, HI) 1.07±0.008, 1.07±0.009 로 두 치료계획 간 차이는 크지 않았다. OAR의 경우 왼쪽 폐의 V5 56.1±6.50%, 50.4±6.30%, V20 20.0±4.15%, 13.52±3.61% 로 Full field VMAT대비 X-Jaw split VMAT에서 V5이 10.0% V20은 32.6% 감소하였다. 심장의 V30은 3.68±1.85%, 2.23±1.52%, 평균 선량은 8.93±1.65 Gy, 7.67±1.52 Gy로 X-Jaw split VMAT에서 V30은 39.3%, 선량은 14.1% 감소하였다. 정상조직인 왼쪽 폐와 심장은 통계적 유의 수치인 p-value 0.05미만으로 나타났다. 결 론 : PTV의 체적이 크고 X Jaw의 길이가 15 cm 이상이 되는 쇄골 상부 림프절을 포함하는 왼쪽 유방암치료의 경우 X-Jaw split VMAT 치료계획은 기존의 치료계획과 동등한 HI와 CI로 유사한 PTV coverage를 유지 하면서 개선된 선량분포를 나타내 OAR인 폐와 심장 등의 방사선량을 줄일 수 있어 부작용을 줄이는데 효과적이라고 생각된다.

Purpose : The usability of X-Jaw split VMAT was evaluated by comparative analysis of the dose distribution between the treatment plan divided by X-Jaw and Full field VMAT treatment plan in left breast cancer treatment including supraclavicular lymph nodes. Materials and Methods : 10 patients with left breast cancer, including supraclavicular lymph nodes, were simulated using vacuum cushion, and 2 Full field Arc VMAT and 4 X-Jaw split Arc VMAT were planned The treatment plan was designed to include more than 95% of the Planning Target Volume (PTV) and to be minimally irradiated in the surrounding Organ at risk (OAR). Dose analysis of PTV and OAR was performed through dose volume histogram (DVH). Results : The Full field VMAT treatment plan and the X-Jaw split VMAT treatment plan of 10 patients were expressed as average values and compared. The difference between the two treatment plans was not large, with a Conformity index (CI) of 1.05±0.04, 1.04±0.03, and a Homogeneity index (HI) of 1.07±0.008, 1.07±0.009. For OAR, V5 in the left lung is 56.1±6.50%, 50.4±6.30%, and V20 is 20.0±4.15%, 13.52±3.61%. Compared to Full field VMAT, V5 decreased by 10.0% V20 by 32.6% in X-Jaw split VMAT. The V30 of the heart is 3.68±1.85%, 2.23±1.52%, and the Mean dose is 8.93±1.65 Gy, 7.67±1.52 Gy. In the X-Jaw split VMAT, V30 decreased by 39.3% and the Mean dose decreased by 14.1%. The left lung and heart, which are normal tissues, were found to have a statistical significance of that p-value is less than 0.05. Conclusion : In the case of left breast cancer treatment, which includes Supraclavicular lymph nodes with a large PTV volume and a length of X Jaw of 15 cm or more, the X-Jaw split VMAT shows improved dose distribution, which can reduce radiation dose of OAR such as lungs and heart, while maintaining similar PTV coverage with HI and CI equivalent to Full field VMAT. It is thought to be effective in reducing radiation complications.

키워드

참고문헌

  1. Sun, T., Lin, X., Zhang, G. et al. Treatment planning comparison of volumetric modulated Arc therapy with the trilogy and the Halcyon for bilateral breast cancer. Radiation Oncology 2021; 16:35 https://doi.org/10.1186/s13014-021-01763-z
  2. Viren, T., Heikkila, J., Myllyoja, K. et al. Tangential volumetric modulated Arc therapy technique for left-sided breast cancer radiotherapy. Radiation Oncology 2015;10:79 https://doi.org/10.1186/s13014-015-0392-x
  3. Boman E, Rossi M, Haltamo M. et al. A new split Arc VMAT technique for lymph node positive breast cancer. Phys Med. 2016 Oct 28:S1120-1797(16)30954-1.
  4. Popescu CC, Olivotto IA, Beckham WA. et al. Volumetric modulated Arc therapy improves dosimetry and reduces treatment time compared to conventional intensity-modulated radiotherapy for locoregional radiotherapy of left-sided breast cancer and internal mammary nodes. Int J Radiat Oncol Biol Phys. 2010 Jan 1;76(1):287-95. https://doi.org/10.1016/j.ijrobp.2009.05.038
  5. Huang B, Fang Z, Huang Y. et al. A dosimetric analysis of volumetric-modulated Arc radiotherapy with Jaw width restriction vs 7 field intensity-modulated radiotherapy for definitive treatment of cervical cancer. Br J Radiol 2014;87:20140183. https://doi.org/10.1259/bjr.20140183
  6. Keil J, Carda J, Reihart J . et al. A dosimetric study using split x-Jaw planning technique for the treatment of endometrial carcinoma. Med Dosim. 2020 Autumn;45(3):278-283. https://doi.org/10.1016/j.meddos.2020.02.001
  7. Poeta, S., Jourani, Y., De Caluwe, A. et al. Split-VMAT technique to control the deep inspiration breath hold time for breast cancer radiotherapy. Radiat Oncol, 2021;16:77 https://doi.org/10.1186/s13014-021-01800-x