Estudo dosimétrico comparativo entre a respiração livre e inspiração forçada com radioterapia conformacional a 3D no tratamento do cancro da mama esquerda
DOI:
https://doi.org/10.25758/set.486Keywords:
Cancro mama esquerda, Radioterapia, Respiração livre, Inspiração forçada, Ventrículo esquerdoAbstract
Introdução – A radioterapia (RT) é uma abordagem terapêutica para tratamento do cancro da mama esquerda. Contudo, diferentes técnicas respiratórias Respiração Livre (FB) e Inspiração Forçada (DIBH) podem ser usadas. Objetivos – Identificar em qual das técnicas de respiração, DIBH ou FB, se consegue obter uma melhor irradiação do Planning Target Volume (PTV) e uma menor dose nos órgãos de risco (OR). Perceber se a técnica de DIBH permite uma diminuição de dose no ventrículo esquerdo. Metodologia – Foram selecionadas 20 doentes, do sexo feminino, com patologia na mama esquerda. Na tomografia computorizada foram feitos os contornos do PTV e dos OAR. Obtiveram-se os dados dosimétricos de cada uma das doentes, com cada um dos dois tipos de técnica respiratória, que foram comparados. Resultados – Em média, a técnica DIBH reduziu a dose média (Dmed) e V20% no pulmão esquerdo, apenas sendo superior em quatro doentes. No ventrículo esquerdo observou-se uma diminuição de Dmed e V30% em todos os doentes. A medula quer em DIBH quer em FB não atingiu o limite de referência; contudo, verificou-se uma melhoria quando usado o DIBH. Conclusões – A técnica respiratória DIBH apresenta menor dose nos órgãos de risco, melhoria na cobertura de dose no PTV, bem como nos índices de conformidade homogeneidade e qualidade comparativamente à técnica de FB.
Downloads
References
Oechsner M, Düsberg M, Borm KJ, Combs SE, Wilkens JJ, Duma MN. Deep inspiration breath-hold for left-sided breast irradiation: analysis of dose-mass histograms and the impact of lung expansion. Radiat Oncol. 2019;14(1):109.
Duane F, Aznar MC, Bartlett F, Cutter DJ, Darby SC, Jagsi R, et al. A cardiac contouring atlas for radiotherapy. Radiother Oncol. 2017;122(3):416-22.
Mkanna A, Mohamad O, Ramia P, Thebian R, Makki M, Tamim H, et al. Predictors of cardiac sparing in deep inspiration breath-hold for patients with left sided breast cancer. Front Oncol. 2018;8:564.
Al-Hammadi N, Caparrotti P, Naim C, Hayes J, Benson KR, Vasic A, et al. Voluntary deep inspiration breath-hold reduces the heart dose without compromising the target volume coverage during radiotherapy for left-sided breast cancer. Radiol Oncol. 2018;52(1):112-20.
Sardaro A, Petruzzelli MF, D’Errico MP, Grimaldi L, Pili G, Portaluri M. Radiation-induced cardiac damage in early left breast cancer patients: risk factors, biological mechanisms, radiobiology, and dosimetric constraints. Radiother Oncol. 2012;103(2):133-42.
Zhao F, Shen J, Lu Z, Luo Y, Yao G, Bu L, et al. Abdominal DIBH reduces the cardiac dose even further: a prospective analysis. Radiat Oncol. 2018;13(1):116.
IBM. SPSS statistics v. 23 documentation [homepage]. IBM; 2018 [updated 2018 Jun 17]. Available from: https://www.ibm.com/support/pages/ibm-spss-statistics-23-documentation
Fontelles MJ. Bioestatística aplicada à pesquisa experimental. Vol. 2. São Paulo: Editora Livraria da Física; 2012. ISBN 9788578611385
Feuvret L, Noël G, Mazeron JJ, Bey P. Conformity index: a review. Int J Radiat Oncol Biol Phys. 2006;64(2):333-42.
Kataria T, Sharma K, Subramani V, Karrthick KP, Bisht SS. Homogeneity index: an objective tool for assessment of conformal radiation treatments. J Med Phys. 2012;37(4):207-13.
Petrova D, Smickovska S, Lazarevska E. Conformity index and homogeneity index of the postoperative whole breast radiotherapy. Open Access Maced J Med Sci. 2017;5(6):736-9.
Shaw E, Kline R, Gillin M, Souhami L, Hirschfeld A, Dinapoli R. Radiation therapy oncology group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys. 1993;27(5):1231-9.
Borges C, Cunha G, Teixeira N. Comparação de diferentes técnicas de irradiação de mama em radioterapia com recurso a acelerador linear em modo de fotões [Comparison of different radiotherapy breast irradiation techniques in LINAC using photon mode]. Saúde Tecnol. 2013;(9):33-39 Portuguese
Pandeli C, Smyth LM, David S, See AW. Dose reduction to organs at risk with deep-inspiration breath-hold during right breast radiotherapy: a treatment planning study. Radiat Oncol. 2019;14(1):223.
Bentzen SM, Constine LS, Deasy JO, Eisbruch A, Jackson A, Marks LB, et al. Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S3-9.
Marks LB, Yorke ED, Jackson A, Haken RK, Constine LS, Eisbruch A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S10-9.
Ferreira MP. Análise do planning target volume e órgãos de risco, com diferentes energias de fotões em 3D-CRT, no cancro do pulmão [dissertation]. Porto: Escola Superior de Saúde, Instituto Politécnico do Porto; 2016.
Emami B. Tolerance of normal tissue to therapeutic radiation. Rep Radiother Oncol. 2013;1(1):123-7.
Czeremszyńska B, Drozda S, Górzyński M, Kępka L. Selection of patients with left breast cancer for deep-inspiration breath-hold radiotherapy technique: results of a prospective study. Rep Pract Oncol Radiother. 2017;22(5):341-8.
Hepp R, Ammerpohl M, Morgenstern C, Nielinger L, Erichsen P, Abdallah A, et al. Deep inspiration breath-hold (DIBH) radiotherapy in left-sided breast cancer: dosimetrical comparison and clinical feasibility in 20 patients. Strahlenther Onkol. 2015;191(9):710-6.
Latty D, Stuart KE, Wang W, Ahern V. Review of deep inspiration breath-hold techniques for the treatment of breast cancer. J Med Radiat Sci. 2015;62(1):74-81.
Valente AM. Comparação de irradiação de mama esquerda: inspiração forçada vs respiração livre [dissertation]. Lisboa: Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa; 2018.
Russo S, Rossi F, Paoletti L, Barca R, Fondelli S, Alpi P, et al. DIBH technique guided by an optical system in left breast irradiation. Phys Med. 2016;32(Suppl 3):197.
Korreman SS, Pedersen AN, Nøttrup TJ, Specht L, Nyström H. Breathing adapted radiotherapy for breast cancer: comparison of free breathing gating with the breath-hold technique. Radiother Oncol. 2005;76(3):311-8.
Comsa D, Barnett E, Le K, Mohamoud G, Zaremski D, Fenkell L, et al. Introduction of moderate deep inspiration breath hold for radiation therapy of left breast: initial experience of a regional cancer center. Pract Radiot Oncol. 2014;4(5):298-305.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The journal Saúde & Tecnologia offers immediate free access to its content, following the principle that making scientific knowledge available to the public free of charge provides greater worldwide democratization of knowledge.
The journal Saúde & Tecnologia does not charge authors any submission or article processing charges (APC).
All content is licensed under a Creative Commons CC-BY-NC-ND license. Authors have the right to: reproduce their work in physical or digital form for personal, professional, or teaching use, but not for commercial use (including the sale of the right to access the article); deposit on their website, that of their institution or in a repository an exact copy in electronic format of the article published by Saúde & Tecnologia, provided that reference is made to its publication in Saúde & Tecnologia and its content (including symbols identifying the journal) is not altered; publish in a book of which they are authors or editors the total or partial content of the manuscript, provided that reference is made to its publication in Saúde & Tecnologia.
