Evrim TEZCANLI, Melahat GARİPAĞAOĞLU, Öznur ŞENKESEN, Halil KÜÇUCÜK, Evren Ozan GÖKSEL, Meriç ŞENGÖZ, Işık ASLAY

RADYOTERAPİ UYGULANAN MEME KANSERLİ HASTALARDA SOLUNUM HAREKETLERİNİN KARŞI MEME DOZUNA ETKİSİ

Amaç: Radyoterapi RT sırasında karşı memeye CB saçılan ışınların artmış ikincil kanser gelişmesiyle ilişkisi bulunmuştur. Bu çalışmada solunum siklusu boyunca karşı meme hacmi ve dozunun değişimi incelenmiştir. Hastalar ve Yöntemler: Meme kanseri tanısıyla meme koruyucu cerrahi veya mastektomi uygulanmış 10 hasta çalışmaya alındı. Bu çalışmaya özel olarak, planlama amacıyla kontrolsuz solunum FB yanında, derin inspirasyon I ve ekspirasyon sonu E bilgisayarlı tomografi görüntüleri de alındı. I ve E imajları FB imajlarına çakıştırıldı. Target ve CB hacimleri aynı Radyasyon Onkoloğu tarafından 3 seride de belirlendi. Doz- hacim verilerini elde etmek amacıyla 3 boyutlu konformal veya yoğunluk ayarlı radyoterapi teknikleri ile FB serisi kullanılarak planlama yapıldı. Daha sonra plan I ve E serilerine aktarıldı. Doz ve hacimde oluşan farklılıklar değerlendirildi. Bulgular: Ortalama CB dozu F ve E arasında anlamlı farklılık göstermemesine p=0.58 karşın F ve I arasında sınırda anlamlı p=0.057 farklılık gösterdi. En yüksek dozu alan %1’lik hacim değeri I ile FB ve I ile E arasında anlamlı olarak p=0.008 ve p=0.03 değişirken FB ile E p=0.35 arasında anlamlı fark gözlenmedi. FB imajları kullanılarak yapılan planlamada CB için öngörülen kısıtlamalar olan; ortalama CB dozunun 1Gy’den az olması ve en yüksek CB dozunun 3,5 Gy’den az olması tüm planlarda sağlandı. Ancak I sırasında 10 hastanın 6’sında maksimum CB dozu ve 1’inde ortalama CB dozu öngörülen sınırları aştı. Sonuç: Hastaların %60’ında ortalama CB dozu belirlenen limitleri aşabileceğinden, kalp ve akciğer dozlarının yanında CB dozunun da solunum hareketleriyle değişimi izlenmelidir

Effect of Breathing on Contralateral Breast Doses in Patients with Breast Carcinoma Receiving Radiotherapy

Objectives: Radiotherapy RT for breast cancer results in scattered radiation doses to the contralateral breast CB which is found to be associated with an increased risk of secondary malignancy. This study investigates the dosimetric and volumetric changes in CB as a consequence of changes during the breathing cycle. Patients- Methods: Ten patients with breast carcinoma underwent breast conservative surgery or mastectomy receiving RT are included. For this study, planning CT computerized tomography images were obtained during deep inspiration I and end of expiration E , as well as free breathing FB in order to simulate respiratory cycle. I and E images were registered to FB. Targets and CB were contoured by the same Radiation Oncologist on 3 image series. Three dimensional conformal or IMRT planning was done to obtain dose - volume information. Treatment plans and dose calculations were constructed using CT images taken during FB. Then, plan was exported to I and E image series. The significance of dose and volume changes was investigated. Results: Mean breast doses changed marginally between FB and I p=0,057 while not significant between FB and E p=0.58 . There was a significant variation between I and F, and I and E for 1% of CB volume receiving maximum dose p=0.008 and p=0.03 while it was not significant between FB and E p=0.35 . Intended dose constrains for CB were achieved for all patients as mean CB doses were less than 1 Gy and max CB doses were less than 3.5 Gy. However, these limitations exceeded during I phase in 6 out of 10 patients regarding maximum CB doses and 1 out of 10 patients for mean CB dose. Conclusion: Contralateral breast dose changes should be considered together with heart and lung dose changes during the different phases of respiratory cycle because maximum CB dose could exceed the upper limit in 60% of patients during I.

Keywords:

breast carcinoma, radiotherapy, contralateral breast dose, breathing,

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