Radioterapija karcinoma leve dojke pri zadržanom dahu u dubokom udisaju nakon konzervacione hirurgije: smanjenje doze na organe u riziku
Sažetak
Uvod/Cilj. Za bolesnice sa dijagnozom karcinoma lijeve dojke, značajan problem predstavlja doza koju će primiti srce, te povišen rizik od koronarne bolesti srca i drugih neželjenih efekata. Kako bi smanjili dozu na srce tokom zračenja tangencijalnim poljima, implementirana je deep inspiration breath-hold (DIBH) tehnika u našem radioterapijskom centru. Cilj ove retrospektivne studije bio je poređenje dozimetrijskih parametara DIBH tehnike na srce, levu prednju descendentnu arteriju (LAD) i ipsilateralno plućno krilo (IL), u odnosu na radioterapijski tretman tokom slobodnog disanja. Metode. Retrospektivno je analizirano dvadeset bolesnica koje su ozračene DIBH tehnikom u našem radioterapijskom centru. Za svaku bolesnicu napravljene su dvije serije kompjuterizovane tomografije, jedna tokom slobodnog disanja i druga za DIBH tehniku. Planovi su se sastojali od dva tangencijalna segmentna polja i jednog direktnog polja sa malim doprinosom doze. Urađena je komparacija doze na organe od rizika: srce, LAD i IL. Rezultati. Izmerena vrednost srednje doze na srce između slobodnog disanja i DIBH tehnike bila je 5,17 Gy i 3,68 Gy, redom (p < 0,0001), dok je srednja procentna vrednost volumena koji prima 25 Gy bila 4,63% i 0,85%, redom (p < 0,0001). Srednja doza na LAD je iznosila 26,09 Gy i 11,89 Gy, redom (p = 0,00014). Srednja procentna vrednost volumena IL koji prima 20 Gy bila je 15,16% i 13,26%, redom (p = 0,0007). Zaključak. Uvođenje DIBH tehnike u radioterapijski tretman kod bolesnica sa karcinomom lijeve dojke statistički značajno smanjuje dozu koju će primiti okolni organi od rizika, naročito srce i LAD, uz optimalnu pokrivenost ciljnog volumena.
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