Sol meme radyoterapisinde brakial pleksus, karotis arter ve tiroid dozlarının değerlendirilmesi

Year 2022, Volume: 13 Issue: 46, 174 - 181, 01.08.2022

Gökçen İnan , Osman Vefa Gül , Hamit Başaran

https://doi.org/10.17944/mkutfd.1002684

Abstract

Amaç: Meme kanserinde radyoterapi (RT) uygulaması hastalığın kontrolünde ve sağkalımında önemli bir yere sahiptir. Genel sağkalım sürelerinin artmasına bağlı olarak meme kanseri tedavisinde görülen yan etkilerin önemi artmıştır. Bu çalışmada RT uygulanan meme kanseri olgularda, brakial pleksus, karotis arter ve tiroid dozlarının değerlendirilmesi amaçlandı.
Yöntem: Çalışmamızda radikal mastektomi yapılmış 15 sol meme kanseri hastaya, alan içinde alan (Field in Field (FinF)), statik yoğunluk ayarlı radyoterapi (S-YART) ve dinamik yoğunluk ayarlı radyoterapi (D-YART) teknikleri ile üç farklı radyoterapi planları hazırlandı. Planlar planlanan hedef hacim (Planned Target Volume-(PTV)) dozları, konformite indeksi (CI) ve homojenite indeksi (HI) açısından değerlendirildi. Kritik organlar olarak brakial pleksus, sol karotis arter ve tiroid dozları karşılaştırıldı.
Bulgular: PTV’ nin aldığı ortalama dozlar üç teknik içinde benzer bulundu. Tiroidin Dort, V20, V30 (Gy) doz değerleri S-YART tekniğinde, FinF ve D-YART tekniklerine göre anlamlı olarak azaldı (p<0.05). Tiroidin V45 (Gy) değeri ise D-YART ve S-YART tekniklerinde anlamlı olarak azaldığı görüldü (p değerleri sırasıyla 0.006, 0.005). Brakial pleksus Dort (Gy) ve V45 (Gy) değerleri D-YART ve S-YART tekniklerinde FinF tekniğine göre anlamlı olarak daha düşük bulundu (p<0.05). Sol karotis arter Dort değeri S-YART tekniğinde anlamlı olarak azaldı (p=0.012).
Sonuç: Radikal mastektomi uygulanmış sol memeye yönelik radyoterapi tedavisinde brakial pleksus, sol karotis arter ve tiroid dozlarının S-YART ve D-YART tekniklerinde daha iyi korunduğu bulundu. Hastalara tedavi planı seçimlerinde bu kritik yapıların aldığı dozlara bakılarak kişiye uygun planlama tercih edilmelidir.

Keywords

FinF, meme kanseri, radyoterapi, Yoğunluk ayarlı radyoterapi

Evaluation of brachial plexus, carotid artery and thyroid doses in left breast radiotherapy

Abstract

Objective: In breast cancer radiotherapy (RT) application has an important role in the control and survival of the disease. In this study, it was aimed to evaluate the brachial plexus, carotid artery and thyroid doses in breast cancer patients who underwent RT.
Methods: Fifteen left breast cancer patients who underwent radical mastectomy were selected for our study. Three different radiotherapy plans were prepared with field-in-field (Field in Field (FinF)), static intensity modulated radiotherapy (S-IMRT) and dynamic intensity modulated radiotherapy (D-IMRT) techniques. Plans were evaluated in terms of planned target volume (PTV) doses, conformity index (CI) and homogeneity index (HI). Brachial plexus, left carotid artery and thyroid doses were compared as critical organs.
Results: The mean doses received by PTV were similar for the three techniques. Dort, V20, V30 (Gy) dose values of the thyroid were significantly decreased in the S-IMRT technique compared to the FinF and D-IMRT techniques (p<0.05). The V45 (Gy) value of the thyroid was significantly decreased in D-IMART and S-IMART techniques (p values 0.006, 0.005, respectively). Brachial plexus Dort (Gy) and V45 (Gy) values were found to be significantly lower in D-IMART and S-IMART techniques compared to FinF technique (p<0.05). Left carotid artery Dort value decreased significantly in S-IMRT technique (p=0.012).
Conclusion: It was found that brachial plexus, left carotid artery and thyroid doses were better preserved in D-IMART and S-IMART techniques in radiotherapy treatment for left breast that underwent radical mastectomy. When choosing a treatment plan for patients, individual planning should be preferred by considering the doses of critical structures.

Keywords

Finf, breast cancer, Intensity modulated radiotherapy

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