Mastektomi sonrası sol meme kanserli olgularda modern tedavi planlama tekniklerinin dozimetrik karşılaştırılması
Küçük Resim Yok
Tarih
2017
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Meme kanseri kadınlarda en sık görülen kanser türüdür. Meme kanserinde radyoterapi, hem küratif hem de palyatif olarak uygulanabilmektedir. Meme kanseri tedavisi için radyoterapide büyük gelişmeler olmaktadır. Bu gelişmeler, planlanan hedef hacmin maksimum dozu alması sağlanırken, aynı zamanda çevresindeki sağlıklı dokuların minimum dozu almasını amaçlar. Bu çalışmanın amacı; mastektomi sonrası sol meme kanserli 10 hastada alan içinde alan field in field-FIF) ve volumetrik ayarlı ark terapi (volumetric modulated arc therapy-VMAT) teknikleri kullanılarak uygulanacak en uygun tedavi tekniğinin belirlenmesidir. Çalışmada, iki teknikte de her bir hasta için her fraksiyonunda göğüs duvarına 0.3 cm bolus eklenerek doz hesaplatılması yapılmıştır. Oluşan tedavi planlarından doz hacim histogramları (dose volume histogram-DVH) yardımıyla planlanan hedef hacmin planning target volume-PTV) ve risk altındaki sağlıklı dokuların aldığı dozlar belirlenmiştir. Her iki planlama için toplam monitör ünit (MU) değerleri hesaplanmıştır. Planın kalitesi için homojenite indeksi (homogeneity index-HI) ve uygunluk sayısı (conformation number-CN) hesaplanmıştır. Doz dağılımı açısından istatistiksel bir fark olup olmadığını incelemek için istatistiksel çalışma yapılmıştır. Bu çalışmanın sonucunda veriler incelendiğinde, PTV' nin homojen doz dağılımı için VMAT tekniğinin FIF tekniğine oranla daha iyi, toplam MU için ise FIF tekniğinin daha avantajlı olduğu görülmüştür. En ideal HI ve CN değerlerine sahip planlama tekniğinin VMAT olduğu görülmüştür. Risk altında kalan sağlıklı dokulardan kalbin, brakiyal pleksus' un ve integral dozun Dmean'i, sol akciğerin V5'i, tüm akciğerin, sağ memenin, tiroidin ve özofagusun FIF tekniğinde daha iyi korunduğu görülmüştür. Kalbin ve sol akciğerin V20'sinin ve sol inen koroner arter (left anterior descending-LAD)'in Dmean'inin aldığı dozun her iki teknikte birbirine yakın olduğu, LAD'ın, brakiyal pleksusun ve integral dozun Dmaks'ının aldığı dozun VMAT tekniğinde daha az olduğu görülmüştür
Breast cancer is the most common type of cancer among women. Both curative and palliative radiotherapy can be applied in breast cancer radiotherapy. Major advances are happening in radiotherapy for breast cancer treatment. These advances aim at ensuring that planning target volume receives maximal dose while surrounding healthy tissues receive minimal dose at the same time. The purpose of this study is to determine the most appropriate treatment technique by comparing the field in field (FIF) technique and volumetric modulated arc therapy (VMAT) technique applied to ten patients with left-sided breast cancer after mastectomy. In the study, dose calculations were made with the application of a 0.3 cm bolus to the chest wall of each patient for each fraction in both techniques. The doses received by planning target volume (PTV) and healthy tissues at risk were determined for each treatment plan by means of dose volume histograms (DVH). Total monitor unit (MU) values were calculated for both plans. The homogeneity index (HI) and conformation number (CN) were calculated for the quality assessment of each plan. A statistical study was conducted to investigate whether there is a statistical difference in terms of dose distribution. When the data were analyzed, as a result of this study, it was found that the VMAT technique is better for the homogeneous dose distribution in PTV than the FIF technique while the FIF technique is more advantageous for total MU. It was found that as a planning technique the VMAT has the most ideal HI and CN values. It was found that the healthy tissues at risk including heart, brachial plexus and integral dose Dmean, left lung V5, whole lung, right breast, thyroid and esophagus are better preserved in FIF technique. It was found that the dose received by left anterior descending (LAD) and brachial plexus and integral dose Dmax are less in the VMAT technique as the doses of V20 of heart and left lung and LAD Dmean in both techniques are close to each other.
Breast cancer is the most common type of cancer among women. Both curative and palliative radiotherapy can be applied in breast cancer radiotherapy. Major advances are happening in radiotherapy for breast cancer treatment. These advances aim at ensuring that planning target volume receives maximal dose while surrounding healthy tissues receive minimal dose at the same time. The purpose of this study is to determine the most appropriate treatment technique by comparing the field in field (FIF) technique and volumetric modulated arc therapy (VMAT) technique applied to ten patients with left-sided breast cancer after mastectomy. In the study, dose calculations were made with the application of a 0.3 cm bolus to the chest wall of each patient for each fraction in both techniques. The doses received by planning target volume (PTV) and healthy tissues at risk were determined for each treatment plan by means of dose volume histograms (DVH). Total monitor unit (MU) values were calculated for both plans. The homogeneity index (HI) and conformation number (CN) were calculated for the quality assessment of each plan. A statistical study was conducted to investigate whether there is a statistical difference in terms of dose distribution. When the data were analyzed, as a result of this study, it was found that the VMAT technique is better for the homogeneous dose distribution in PTV than the FIF technique while the FIF technique is more advantageous for total MU. It was found that as a planning technique the VMAT has the most ideal HI and CN values. It was found that the healthy tissues at risk including heart, brachial plexus and integral dose Dmean, left lung V5, whole lung, right breast, thyroid and esophagus are better preserved in FIF technique. It was found that the dose received by left anterior descending (LAD) and brachial plexus and integral dose Dmax are less in the VMAT technique as the doses of V20 of heart and left lung and LAD Dmean in both techniques are close to each other.
Açıklama
Anahtar Kelimeler
Fizik ve Fizik Mühendisliği, Physics and Physics Engineering
