乳癌四分之一野与单中心技术

1、1.文章在文章在 90 年代初出现（国内年代初出现（国内 2000 年后），年后），03 年参加放疗标年参加放疗标准化临床试验，准化临床试验，06、08、09 年还有技术改进文章年还有技术改进文章(Published Online August 21 2006)Original ArticleAn evaluation of three tangential breast irradiation techniques in Hong KongMaria Y.Y. Law a1c1, Fion W.K. Cheung a1, Vincent W.C. Wu a1, Venus W.C. Tsan

2、g a1, Rainnie W.Y. Kwan a1, Johnny Y.T. Cheng a1 and Fatson K.F. Wong a1a1 Department of Optometry and Radiography, Hong Kong Polytechnic University, Hong KongArticle author querylaw my PubMed Google Scholar cheung fw PubMed Google Scholar wu vw PubMed Google Scholar tsang vw PubMed Google Scholar k

3、wan rw PubMed Google Scholar cheng jy PubMed Google Scholar wong fk PubMed Google Scholar AbstractBackground and Purpose: Loco-regional radiotherapy after breast conserving surgery significantly reduces the risk of recurrence but may induce complications in the lungs. The complications are related t

4、o the lung volume irradiated and the lung dose delivered. The purpose of this study was to evaluate three tangential breast irradiation techniques i.e. conventional technique, gantry tilting technique and half-beam block technique in terms of the percentage of irradiated lung volume and high dose lu

5、ng volume for patients of different sizes.Materials and Method: Treatment planning of the three tangential breast irradiation techniques was performed using the CT scans of 20 patients with early-stage breast cancer after lumpectomy.Results: When compared with conventional technique, both half beam

6、block technique and gantry tilting technique irradiated a significantly smaller percentage of lung volume and delivered a smaller percentage of high dose (above 30 Gy) volume in the lung. Patients with large breasts had a significantly higher percentage of lung volume irradiated to above 30Gy than t

7、hose patients with small and medium breasts. The combined effect of tangential separation and technique only produced significant effect on the percentage of total lung volume irradiated but not on the high dose volume.Conclusions: Gantry tilting and half-beam block techniques can reduce a significa

8、nt amount of lung volume and high dose lung volume. Half-beam block technique is recommended for small and medium breast size while for large breast size, gantry tilting technique is preferred.#【2006 online：】Journal of Radiotherapy in Practice (2000), 2:1:9-15 Cambridge University PressCopyright 200

9、0 Cambridge University Pressdoi:10.1017/S1460396900000030 Original ArticleAn evaluation of three tangential breast irradiation techniques in Hong KongMaria Y.Y. Law a1c1, Fion W.K. Cheung a1, Vincent W.C. Wu a1, Venus W.C. Tsang a1, Rainnie W.Y. Kwan a1, Johnny Y.T. Cheng a1 and Fatson K.F. Wong a1a

10、1 Department of Optometry and Radiography, Hong Kong Polytechnic University, Hong KongArticle author querylaw my PubMed Google Scholar cheung fw PubMed Google Scholar wu vw PubMed Google Scholar tsang vw PubMed Google Scholar kwan rw PubMed Google Scholar cheng jy PubMed Google Scholar wong fk PubMe

11、d Google Scholar AbstractBackground and Purpose: Loco-regional radiotherapy after breast conserving surgery significantly reduces the risk of recurrence but may induce complications in the lungs. The complications are related to the lung volume irradiated and the lung dose delivered. The purpose of

12、this study was to evaluate three tangential breast irradiation techniques i.e. conventional technique, gantry tilting technique and half-beam block technique in terms of the percentage of irradiated lung volume and high dose lung volume for patients of different sizes.Materials and Method: Treatment

13、 planning of the three tangential breast irradiation techniques was performed using the CT scans of 20 patients with early-stage breast cancer after lumpectomy.Results: When compared with conventional technique, both half beam block technique and gantry tilting technique irradiated a significantly s

14、maller percentage of lung volume and delivered a smaller percentage of high dose (above 30 Gy) volume in the lung. Patients with large breasts had a significantly higher percentage of lung volume irradiated to above 30Gy than those patients with small and medium breasts. The combined effect of tange

15、ntial separation and technique only produced significant effect on the percentage of total lung volume irradiated but not on the high dose volume.Conclusions: Gantry tilting and half-beam block techniques can reduce a significant amount of lung volume and high dose lung volume. Half-beam block techn

16、ique is recommended for small and medium breast size while for large breast size, gantry tilting technique is preferred.(Published Online August 21 2006)Key Words: Breast cancer; radiotherapy technique; tangential irradiation. Correspondence:c1 Correspondence to: Maria Law, Department of Optometry a

17、nd Radiography, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. E-mail: .hk PreviousNext International Journal of Radiation Oncology * Biology * PhysicsVolume 19, Issue 4 , Pages 1037-1040, October 1990A nondivergent three field matching technique for breast irradiati

18、onJames C.H. Chu, Ph.D. AFFILIATIONSReprint requests to; James C. H. Chu, Ph.D., Department of Radiation Oncology, Fox Chase Cancer Center, 7701 Burholme Ave., Philadelphia, PA 19111., Lawrence J. Solin, M.D., Chin Chang Hwang, M. S., Barbara Fowble, M.D., Gerald E. Hanks, M.D., Robert L. Goodman, M

19、.D.Accepted 26 April 1990. Abstract Abstract + References PDF References Abstract Effective radiation therapy to intact breasts requires the delivery of adequate dose to a large target volume using complex beam arrangements. A semi-empirical method is described to determine the correct gantry, colli

20、mator, and couch positions for a geometrically accurate field match among adjoining radiation beams. The technique uses a metal rod and chain combination to aid determination of the proper couch setting under remote fluoroscopy control. A couch position error of more than half a degree is easily det

21、ectable by this technique.Keywords: Breast irradiation, Field matchingTECHNICAL NOTEA virtual matching technique for three-field breast irradiation using 3-D planning Purchase$ 31.50Jonathan B. Straussa, , , Michael C. Kirka, 1, Sea S. Chena, Anand P. Shaha, Benjamin T. Gieldaa, James C. Chua, Juliu

22、s V. Turiana and Adam DicklerbaRush University Medical Center, Department of Radiation Oncology, Chicago, IL 60612, USAbLittle Company of Mary Hospital, Department of Radiation Oncology, Evergreen Park, IL 60805, USAReceived 1 August 2008; revised 10 January 2009; accepted 3 March 2009. Available on

23、line 3 April 2009. AbstractPatients with breast cancer are often treated with radiation to the breast (or chest wall) and draining regional lymph nodes. This is typically performed with a three-field technique in which an anterior supraclavicular field is matched to opposed tangent fields. A single

24、isocenter technique is not always possible. Several techniques have been described to create a perfect match using a conventional simulator. We describe and test a simple, fast and accurate technique to estimate the couch and collimator angles required for a perfect geometric match using 3-D treatme

25、nt planning software. This method requires no mathematical formulae and is verifiable relative to patient anatomy.An external skin contour is created on the axial slice at the match line and displayed with a 3-D representation. Using a beams eye view (BEV) of a tangent field, small couch and collima

26、tor rotation adjustments are made sequentially until the contour edges are superimposed. The virtual external contour technique was easy to use, gave verification of the match in the BEV and yielded estimates of couch and collimator rotations very close to those calculated using published formulae.K

27、eywords: Breast cancer; Radiation; Field matching; Three-field techniqueArticle OutlineIntroductionTechniqueSimulation Treatment planning Example ResultsDiscussionReferences2.四分之一野的剂量匹配好四分之一野的剂量匹配好（而转床的剂量匹配差些）定位要求高：胶片剂量验证1: Int J Radiat Oncol Biol Phys. 1994 Feb 1;28(3):753-60. LinksA mono isocentri

28、c technique for breast and regional nodal therapy using dual asymmetric jaws.单个等中心及不对称野的乳腺及区域淋巴结治疗技术单个等中心及不对称野的乳腺及区域淋巴结治疗技术Klein EE, Taylor M, Michaletz-Lorenz M, Zoeller D, Umfleet W.Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO 63110.PURPOSE: Definiti

29、ve radiation therapy for breast cancer with regional nodal involvement often introduces treatment of adjacent abutted regions. Many methods describe techniques to achieve an effective transverse plane match. Our facility recently adopted a matching technique using asymmetric jaws to beam-split all p

30、ortals along the central axis plane. Our technique uses one isocenter to treat the opposed tangential breast fields, the supraclavicular port and the posterior axillary field. METHODS AND MATERIALS: Our linear accelerator has four collimator jaws capable of being set independently. The longitudinal

31、(Y) jaws beam-split all the portals at the match plane, namely the upper border of the tangential beams and the bottom border of the nodal fields. The transverse (X) jaws define the lateral borders of the nodal fields, and in a near beam-split fashion in conjunction with customized Cerrobend, block

32、the lung for the tangential beams. The unique isocenter is chosen along the mid-bridge through the tangential match plane. Dosimetric qualities and calculational techniques of the asymmetric beams were analyzed with ionimetric water scans, ion chamber studies, and film. The match-line is clinically

33、confirmed with composite port films. RESULTS: 1）Our dosimetric studies show asymmetric jaws provide nearly equivalent field edge definition and superior absorption in comparison with Cerrobend blocks. The use of one isocenter results in a reduction of in-room treatment time by a factor of two. The b

34、urden of lifting heavy Cerrobend blocks has been removed. A composite port film, which includes the medial tangential and supraclavicular ports, shows a perfect match-line in all cases. （胶片剂量测量表明切线野与锁骨上野得到完全匹配）（胶片剂量测量表明切线野与锁骨上野得到完全匹配）2）Similar composite port films taken with our previous technique o

35、f geometric matching with collimator and table angulation exhibit slight overlap or underdose regions in many cases（转床的剂量匹配略差，常有些过或欠剂量）转床的剂量匹配略差，常有些过或欠剂量）. CONCLUSION: Our treatment technique takes full advantage of dual asymmetric jaws （四分之一野）to achieve a perfect match-line, necessitates only one i

36、socenter and set-up point, and supplies more absorption in reference to lung and contralateral breast dose. The pure match-line is accompanied by the fact that the patient does not have to move in any direction.（理想（理想的匹配线要求病人不得移动）的匹配线要求病人不得移动）PMID: 8113122 PubMed - indexed for MEDLINE3）找原文）找原文-四分之一野

37、1: Int J Radiat Oncol Biol Phys. 1990 Jul;19(1):183-8#A technique for treating local breast cancer using a single set-up point and asymmetric collimation.Rosenow UF, Valentine ES, Davis LW.Department of Radiation Oncology, Albert Einstein College of Medicine, NY, NY.Using both pairs of asymmetric ja

38、ws of a linear accelerator local-regional breast cancer may be treated from a single set-up point. This point 是位于匹配线处is placed at the abutment of the supraclavicular fields with the medial and lateral tangential fields. Positioning the jaws to create a half-beam superiorly permits treatment of the s

39、upraclavicular field. Positioning both jaws asymmetrically at midline to define a single beam in the inferoanterior quadrant（四分之一野） permits treatment of the breast from medial and lateral tangents. The highest possible matching accuracy （最高的匹配精度）（最高的匹配精度）between the supraclavicular and tangential fi

40、elds is inherently provided by this technique. For treatment of all fields at 100 cm source to axis distance (SAD) the lateral placement and depth of the set-up point may be determined by simulation and simple trigonometry. We elaborate on the clinical procedure. For the technologists treatment of a

41、ll fields from a single set-up point is simple and efficient（对技术员而言，所有野只用一个等中心更简单有效）（对技术员而言，所有野只用一个等中心更简单有效）. Since the tissue at the superior border of the tangential fields is generally firmer than in mid-breast（由于切线野的上边界与中部乳房相比是更固定）由于切线野的上边界与中部乳房相比是更固定）, greater accuracy in day-to-day set-up is p

42、ermitted（重复定位更准确）（重复定位更准确）. This technique eliminates the need for table angles even when tangential fields only are planned（无需转床）（无需转床）. Because of half-beam collimation the limit to the tangential field length is 20 cm. Means will be suggested to overcome this limitation in the few cases where it

43、occurs. Another modification is suggested for linear accelerators with only one independent pair of jaws.PMID: 2380084 PubMed - indexed for MEDLINE4）1: Med Dosim. 1994 Summer;19(2):107-10. LinksThree-field breast irradiation technique using tangential quarter fields.Li C, Torigoe EW, Dunning A, Halb

44、erg F, Evans R.Radiation Oncology Department, Marin General Hospital, Greenbrae, CA 94904.We have developed and implemented in clinical practice an isocentric three-field breast irradiation technique using tangential quarter fields. In this technique, the same isocenter is used for the supraclavicul

45、ar and the tangential breast fields. The superior-posterior corner of the tangential breast fields is placed at the central axis by asymmetric collimation of both the length and the width of the field. Consequently, the beam divergence at both the superior and posterior edges is eliminated, allowing

46、 a perfect geometric match between the posterior borders of both tangential breast fields and the supraclavicular field without table rotation. Compared to conventional techniques requiring table rotations, the present method produces a more uniform dose distribution in the target volume and require

47、s significantly less simulation time（此技术在靶（此技术在靶体积内产生更均匀的剂量体积内产生更均匀的剂量,模拟定位的时间减少）模拟定位的时间减少）.PMID: 7916976 PubMed - indexed for MEDLINE5）四分之一野）四分之一野1: Radiother Oncol. 1993 Sep;28(3):228-32. LinksThree-field isocentric breast irradiation using asymmetric jaws and a tilt board.Marshall MG.Department o

48、f Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1088.Perfect abutment of medial and lateral tangential breast portals with the adjacent supraclavicular field may be achieved with ease. A simple and safe approach was developed using a tilt board and new te

49、chnology that is standard on a popular linear accelerator. The patient is secured on a tilt board as a means to level the chest wall. Isocenter is placed at depth on the matchline, where asymmetric jaws are used to produce non-divergent field edges and a perfect abutment. This is done without the ne

50、ed for table or collimator rotations, beam-splitters, or vertical cephalad blocks. The dorsal beam edge of the tangents is made coplanar by rotating the gantry more than 180 degrees. This procedure produces a dosimetrically sharp field edge （在剂量上得到清晰的野边界）（在剂量上得到清晰的野边界）and eliminates concern about bl

51、ock transmission and excess dose to the contralateral breast. Set-up is fast, and the steps involved are simple and few. Advantages and limitations of this technique are presented.PMID: 8256000 PubMed - indexed for MEDLINE5）1: Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):139-46. LinksInternal mamm

52、ary node coverage: an investigation of presently accepted techniques.Arthur DW, Arnfield MR, Warwicke LA, Morris MM, Zwicker RD.Department of Radiation Oncology, Medical College of Virginia Hospitals of Virginia Commonwealth University, Richmond, VA, USA. PURPOSE: Recent publicati

53、ons have generated a renewed interest in regional nodal treatment to include the ipsilateral supraclavicular and internal mammary nodes (IMN). The purpose of this study is to evaluate three presently accepted treatment techniques for coverage of the intact breast and ipsilateral lymph node regions a

54、nd to construct recommendations regarding the utilization of these techniques. METHODS AND MATERIALS: Anatomic data were obtained from five randomly selected patients with computerized tomography (CT) in treatment position. Three patients presented with cancer of the left breast and two with cancer

55、of the right. Using the Pinnacle 3-D planning system, normal tissue volumes of breast, ipsilateral lung, heart, sternum, and the IMN target were delineated for each patient. Three accepted techniques used to treat ipsilateral breast, internal mammary and supraclavicular nodes (extended tangents, 5-f

56、ield, partly wide tangents) were configured and compared to a supraclavicular field matched to standard tangential fields. A dosage of 50 Gy in 25 fractions was prescribed to the target volume. Dose-volume histograms (DVH) were generated and analyzed with regard to target volume coverage and lung/heart volumes treated. RESULTS: All of the treatment techniques covering IMN include at least 10% more lung and heart volume than that covered by standard tangential fields. The relative lung and heart volumes treated with each technique were consistent from