Sol meme radyoterapisinde brakial pleksus, karotis arter ve tiroid dozlarinin degerlendirilmesi

Abstract

Amaç: Meme kanserinde radyoterapi (RT) uygulamasi hastaligin kontrolünde ve sagkaliminda önemli bir yere sahiptir. Genel sagkalim sürelerinin artmasina bagli olarak meme kanseri tedavisinde görülen yan etkilerin önemi artmistir. Bu çalismada RT uygulanan meme kanseri olgularda, brakial pleksus, karotis arter ve tiroid dozlarinin degerlendirilmesi amaçlandi. Yöntem: Çalismamizda radikal mastektomi yapilmis 15 sol meme kanseri hastaya, alan içinde alan (Field in Field (FinF)), statik yogunluk ayarli radyoterapi (S-YART) ve dinamik yogunluk ayarli radyoterapi (D-YART) teknikleri ile üç farkli radyoterapi planlari hazirlandi. Planlar planlanan hedef hacim (Planned Target Volume-(PTV)) dozlari, konformite indeksi (CI) ve homojenite indeksi (HI) açisindan degerlendirildi. Kritik organlar olarak brakial pleksus, sol karotis arter ve tiroid dozlari karsilastirildi. Bulgular: PTV’ nin aldigi ortalama dozlar üç teknik içinde benzer bulundu. Tiroidin Dort, V20, V30 (Gy) doz degerleri S-YART tekniginde, FinF ve D-YART tekniklerine göre anlamli olarak azaldi (p<0.05). Tiroidin V45 (Gy) degeri ise D-YART ve S-YART tekniklerinde anlamli olarak azaldigi görüldü (p degerleri sirasiyla 0.006, 0.005). Brakial pleksus Dort (Gy) ve V45 (Gy) degerleri D-YART ve S-YART tekniklerinde FinF teknigine göre anlamli olarak daha düsük bulundu (p<0.05). Sol karotis arter Dort degeri S-YART tekniginde anlamli olarak azaldi (p=0.012). Sonuç: Radikal mastektomi uygulanmis sol memeye yönelik radyoterapi tedavisinde brakial pleksus, sol karotis arter ve tiroid dozlarinin S-YART ve D-YART tekniklerinde daha iyi korundugu bulundu. Hastalara tedavi plani seçimlerinde bu kritik yapilarin aldigi dozlara bakilarak kisiye uygun planlama tercih edilmelidir.

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.