In a study of interobserver variations in delineating the breast for treatment planning, Reed et al. reported that interobserver differences were smallest at the breast skin surface, owing to the use of an automatically generated external skin contour [1]. Accordingly, the RTOG breast atlas extends the breast/chest wall CTV to the skin [2]. However, including the skin into the breast CTV is in discrepancy with planning studies that reported cropping CTV [3] or PTV to 5 mm [4] or 6 mm under the skin surface [5]. On one hand, including the skin can impact on the need to use a bolus or a skin flash technique [6], with consequently increased risk of skin toxicity. On the other hand, excluding the skin could cause an unwanted underdosage. There is a need to discuss whether the breast's skin should be a treatment target or not.
展开▼
机译：在对观察者之间的差异进行乳腺划定治疗计划的研究中，Reed等人。报告指出，由于使用了自动生成的外部皮肤轮廓，观察者之间的差异在乳房皮肤表面最小。因此，RTOG乳房图谱将乳房/胸部壁CTV延伸至皮肤[2]。但是，包括皮肤在内的CTV与计划研究不一致，该研究报道了将CTV [3]或PTV裁剪到皮肤表面以下5 mm [4]或6 mm [5]。一方面，包括皮肤在内可能会影响使用推注或皮肤闪光技术的需求[6]，从而增加皮肤毒性的风险。另一方面，排除皮肤会导致不必要的剂量不足。有必要讨论乳房的皮肤是否应该成为治疗目标。
展开▼
