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Accelerated Partial Breast Irradiation: Using the CyberKnife as the Radiation Delivery Platform in the Treatment of Early Breast Cancer

机译:加速局部乳房辐射:使用电子刀作为放射传递平台治疗早期乳腺癌

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摘要

We evaluate the CyberKnife (Accuray Incorporated, Sunnyvale, CA, USA) for non-invasive delivery of accelerated partial breast irradiation (APBI) in early breast cancer patients. Between 6/2009 and 5/2011, nine patients were treated with CyberKnife APBI. Normal tissue constraints were imposed as outlined in the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 (NSABP/RTOG) Protocol (Vicini and White, 2007). Patients received a total dose of 30 Gy in five fractions (group 1, n = 2) or 34 Gy in 10 fractions (group 2, n = 7) delivered to the planning treatment volume (PTV) defined as the clinical target volume (CTV) +2 mm. The CTV was defined as either the lumpectomy cavity plus 10 mm (n = 2) or 15 mm (n = 7). The cavity was defined by a T2-weighted non-contrast breast MRI fused to a planning non-contrast thoracic CT. The CyberKnife Synchrony system tracked gold fiducials sutured into the cavity wall during lumpectomy. Treatments started 4–5 weeks after lumpectomy. The mean PTV was 100 cm3 (range, 92–108 cm3) and 105 cm3 (range, 49–241 cm3) and the mean PTV isodose prescription line was 70% for groups 1 and 2, respectively. The mean percent of whole breast reference volume receiving 100 and 50% of the dose (V100 and V50) for group 1 was 11% (range, 8–13%) and 23% (range, 16–30%) and for group 2 was 11% (range, 7–14%) and 26% (range, 21–35.0%), respectively. At a median 7 months follow-up (range, 4–26 months), no acute toxicities were seen. Acute cosmetic outcomes were excellent or good in all patients; for those patients with more than 12 months follow-up the late cosmesis outcomes were excellent or good. In conclusion, the lack of observable acute side effects and current excellent/good cosmetic outcomes is promising. We believe this suggests the CyberKnife is a suitable non-invasive radiation platform for delivering APBI with achievable normal tissue constraints.
机译:我们评估了Cyber​​Knife(Accuray Incorporated,美国加利福尼亚州桑尼维尔)在早期乳腺癌患者中无创递送加速局部乳房照射(APBI)的情况。在6/2009至5/2011之间,有9名患者接受了Cyber​​Knife APBI治疗。如《国家外科手术辅助乳房和肠项目B-39 /放射治疗肿瘤学》第0413组(NSABP / RTOG)协议(维奇尼和怀特,2007年)所述,施加了正常的组织约束。患者分五部分(组1,n =(2)接受总剂量为30 Gy,分十部分(组2,n = 7)接受剂量为34 Gy,达到计划治疗量(PTV),定义为临床目标量(CTV) )+2 mm。 CTV被定义为肿块切除术腔加10mm(n = 2)或15mm(n = 7)。通过与计划中的非对比胸部CT融合的T2加权非对比乳腺MRI定义腔。 Cyber​​knife Synchrony系统跟踪在乳房切除术期间将金基准点缝合到腔壁中。肿块切除术后4-5周开始治疗。第1组和第2组的平均PTV为1003cm3(范围为92–108 cm3)和105 cm3(范围为49–241 cm3),平均PTV等剂量处方线为70%。第一组的接受100和50%剂量(V100和V50)的全乳参考体积的平均百分比对于第1组分别为11%(范围8-13%)和23%(范围16-30%)。分别为11%(范围7–14%)和26%(范围21–35.0%)。在7个月的中位随访期(4–26个月)中,未发现急性毒性。所有患者的急性美容效果均良好或良好。对于那些随访超过12个月的患者,晚期美容效果是优异的或良好的。总而言之,缺乏可观察到的急性副作用和当前优良/良好的美容效果是有希望的。我们认为,这表明“射波刀”是一种合适的非侵入性放射平台,可用于以可实现的正常组织约束传递APBI。

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