SELECTIVE CONTOURING OF SOFT TISSUES OF THE ANTERIOR CHEST WALL IN PATIENTS WITH BREAST CANCER AFTER MASTECTOMY AND RECONSTRUCTIVE PLASTIC SURGERY WITH ENDOPROSTHETICS BEFORE RADIOTHERAPY FOLLOWING A HYPOFRACTIONATED REGIMEN

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to radiotherapy, and can be used for radiotherapy according to a hypofractionated regimen of patients with breast cancer after mastectomy and reconstructive plastic surgery with endoprosthetics. Soft tissues of the anterior chest wall are selectively contoured before radiotherapy, for the purpose whereof the subcutaneous lymphatic plexus retreating 3 to 5 mm from the skin surface inward is included in the clinical target volume (CTV). The posterior border of the CTV therein extends along the anterior surface of the pectoral muscle with a transition to the anterior surface of the endoprosthesis in areas thereof not covered by muscle. The lower and upper boundaries are determined at the stage of computer topometry by using radioopaque markers used to form a visual boundary of the irradiated area. Markers are used to mark the course of postoperative scarring. For orientation, the height of the location of the palpable breast tissue in the contralateral mammary gland is used. Medial boundaries are similarly determined with orientation on the contralateral mammary gland. The lateral boundary is determined with orientation on the contralateral mammary gland, anteriorly from the midaxillary line and the lateral thoracic artery. The CTV volume is therein formed by excluding the volume of the endoprosthesis from the CTV. A 0.5 cm retreat for installation error (PTV) is added to the formed CTV volume. The resulting volume is irradiated with a single focal dose of 2.25 Gy for patients with left-sided tumour localisation and 2.5 Gy for patients with right-sided localisation. A total dose of 50 Gy in isoequivalent (isoGy) is supplied, recalculated according the linear-quadratic model a=3 Gy. Irradiation is conducted 5 days a week with a two day break.;EFFECT: method reduces the radiation load on critical organs and systems during radiotherapy due to the irradiation with non-standard single doses.;1 cl, 2 ex