| He Xiantao,Xu Zhuohua,Long Yusong,et al.A comparative study of radiotherapy using three distinct radiotherapy techniques following immediate breast reconstruction for breast cancer[J].Chinese Journal of Radiological Medicine and Protection,2025,45(4):317-324 |
| A comparative study of radiotherapy using three distinct radiotherapy techniques following immediate breast reconstruction for breast cancer |
| Received:August 20, 2024 |
| DOI：10.3760/cma.j.cn112271-20240820-00312 |
| KeyWords:Breast neoplasms Immediate breast reconstruction Intensity modulated radiotherapy Dosimetry |
| FundProject:广西卫生健康委员会自筹经费科研课题(Z-B20231377);中央引导地方项目(2022YRZ0101);广西重点研发计划项目(2021AB12033) |
| Author Name | Affiliation | E-mail | | He Xiantao | Department of Oncology, Liuzhou Worker's Hospital, Liuzhou 545005, China | | | Xu Zhuohua | Department of Oncology, Liuzhou Worker's Hospital, Liuzhou 545005, China | | | Long Yusong | Department of Oncology, Liuzhou Worker's Hospital, Liuzhou 545005, China | | | Tan Junwen | Department of Oncology, Liuzhou Worker's Hospital, Liuzhou 545005, China | | | Li Gang | Department of Oncology, Liuzhou Worker's Hospital, Liuzhou 545005, China | | | Feng Yongfu | Department of Oncology, Liuzhou Worker's Hospital, Liuzhou 545005, China | | | Yang Hui | Department of Oncology, Liuzhou Worker's Hospital, Liuzhou 545005, China | | | Lu Ying | Department of Oncology, Liuzhou Worker's Hospital, Liuzhou 545005, China | | | Wang Zhanyu | Department of Oncology, Liuzhou Worker's Hospital, Liuzhou 545005, China | wzyliuhou@163.com |
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| Abstract:: |
| Objective To investigate the differences in dosimetric parameters for target volumes and organs at risk (OARs), radiation doses to reconstructed tissues, and beam-on time in radiotherapy among helical tomotherapy (HT), volumetric modulated arc therapy (VMAT), and fixed-field intensity-modulated radiotherapy ( F_IMRT ) following immediate breast reconstruction for breast cancer, thereby providing a reference for the selection of clinical radiotherapy techniques. Methods This study retrospectively investigated 15 breast cancer patients who underwent radiotherapy following modified radical mastectomy and immediate breast reconstruction at the Liuzhou Worker's Hospital from August 2018 to July 2023. During target volume delineation, precautions were taken to avoid the reconstructed tissues, which were delineated separately. Customized HT, VMAT, and F_IMRT treatment plans were designed for each patient. The plans were categorized into the HT, VMAT, and F_IMRT groups based on different radiotherapy techniques employed. They were comparatively analyzed through one-way analysis of variance (ANOVA), with multiple comparisons further conducted in the case of significant differences. Results Statistical analyses reveal significant differences in various parameters of target volumes among the three groups of plans (F = 38.73, 14.95, 37.01, 48.05, 35.55, 22.56, 34.30,P < 0.05). Pairwise comparisons indicate that the maximum dose (D2%), minimum dose (D98%), mean dose (Dmean), and the proportion of high-dose volumes within the target volume (V107%and V110%) in both the HT and VMAT groups were significantly better than those in the F_IMRT group. The HT group demonstrated the optimal conformity index (CI), while the VMAT group displayed the superior homogeneity index (HI) compared to the other two groups. In terms of OAR, the V20 of the ipsilateral lung was the lowest in the HT group (F = 14.31,P < 0.05) and the highest in the F_IMRT group (F = 14.31,P < 0.05). However, the V5 and Dmean for both the ipsilateral and contralateral lungs in the HT group significantly surpassed those of the other groups (F = 39.16, 31.91,P < 0.05). The mean dose Dmean (F = 5.57,P < 0.05) of the contralateral breast was significantly reduced in the VMAT group compared to the other two groups. No statistically significant differences were observed for other OARs, including the heart, spinal cord PRV, thyroid, and humeral head (P> 0.05). The radiation doses to reconstructed tissues (Dmax, V53.5, Dmean) ascended in the order of HT, VMAT, and F_IMRT groups (F = 17.69, 17.53, 15.11,P < 0.05). The HT and F_IMRT groups showed similar beam-on times (P> 0.05), both exceeding that of the VMAT group by several folds (F = 28.72,P < 0.05). Conclusions The comparative analysis indicates that the three radiotherapy techniques exhibit distinct advantages and limitations, with F_IMRT demonstrating the least comprehensive advantage. HT can enhance the conformity of target volumes while reducing the overall radiation doses to reconstructed tissues and the crucial indicator V20 in the ipsilateral lung. VMAT demonstrates the highest treatment efficiency, yielding improved dose uniformity in the target volume and reduced radiation doses to the contralateral breast. It is advisable to prioritize HT or VMAT based on actual clinical conditions. |
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