Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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A Study of the Radiotherapy Techniques for the Breast Including Internal Mammary Lymph Nodes

유방 보존술 후 내유림프절을 포함하는 방사선치료 기법에 관한 연구

  • Jeong, Kyoung-Keun (Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center) ;
  • Shim, Su-Jung (Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center) ;
  • You, Sei-Hwan (Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center) ;
  • Kim, Yong-Bae (Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center) ;
  • Keum, Ki-Chang (Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center) ;
  • Kim, Jong-Dae (Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center) ;
  • Suh, Chang-Ok (Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center)
  • 정경근 (연세대학교 의과대학 연세암센터 방사선종양학교실) ;
  • 심수정 (연세대학교 의과대학 연세암센터 방사선종양학교실) ;
  • 유세환 (연세대학교 의과대학 연세암센터 방사선종양학교실) ;
  • 김용배 (연세대학교 의과대학 연세암센터 방사선종양학교실) ;
  • 금기창 (연세대학교 의과대학 연세암센터 방사선종양학교실) ;
  • 김종대 (연세대학교 의과대학 연세암센터 방사선종양학교실) ;
  • 서창옥 (연세대학교 의과대학 연세암센터 방사선종양학교실)
  • Published : 2009.03.30
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Abstract

Purpose: This study was designed to determine the optimum radiotherapy technique for internal mammary node (IMN) irradiation after breast-conserving surgery. Materials and Methods: We selected ten cases of early stage partial mastectomy for plan comparison. Five of the patients were treated to the right-side breast and the rest of the patients were treated to the left-side breast. For each case, four different treatment plans were made to irradiate the entire breast, IMNs and supraclavicular lymph nodes (SCLs). The four planning techniques include a standard tangential field (STF), wide tangential field (WTF), partially wide tangential field (PWT) and a photon-electron mixed field (PEM). We prescribed a dose of 50.4 Gy to the SCL field at a 3 cm depth and isocenter of the breast field. Results: The dose distribution showed clear characteristics depending on the technique used. All of the techniques covered the breast tissue well. IMN coverage was also good, except for the STF, which was not intended to cover IMNs. For the cases of the left-side breasts, the volume of the heart that received more than 30 Gy was larger (in order) for the WTF, PWT, PEM and STF. For radiation pneumonitis normal tissue complication probability (NTCP), the PWT showed the best results followed by the STF. Conclusion: Despite the variety of patient body shapes, the PWT technique showed the best results for coverage of IMNs and for reducing the lung and heart dose.

목적: 유방암 환자에서 부분적 유방절제술 후 내유림프절(internal mammary lymph node: IMN)을 포함하여 방사선 치료하기 위한 최적의 치료 방법을 찾고자 하였다. 대상 및 방법: 초기 유방암으로 부분적 유방절제수술을 받고 방사선치료를 받은 10명의 환자들의 CT simulation 데이터를 얻어서 각 환자들에서 4가지 치료방법을 계획하고 평가하였다. 5명은 오른쪽 유방을, 나머지 5명은 왼쪽 유방을 치료 받았다. 각 환자에서 유방, 쇄골 상부 림프절(supraclavicular lymph node: SCL), IMN (위쪽 3개의 늑골 사이에 있는 림프절만 포함)을 조사하는 치료계획을 하였다. IMN을 조사하는 방법으로 4가지 방식, 즉 표준적인 접선방향 치료(Standard Tangential Field: STF), 확장접선치료 방법(Wide Tangential Field, WTF), 부분 확장접선치료 방법(Partially Wide Tangential Field: PWT), 광자와 전자를 혼합한 방법(Photon-Electron Mixed 5 Field: PEM)을 사용하였다. SCL field는 3 cm에, 유방조직은 중심점에 50.4 Gy를 28회에 나누어 치료하도록 처방하였다. 결과: 각각의 치료 기법은 환자마다 차이는 있었으나 뚜렷한 특징을 보였다. 유방조직의 선량은 각 치료 기법마다 큰 차이가 없었다. IMN는 치료 기법마다 차이가 있으나 STF를 제외한 세 가지 방법은 대체로 IMN을 잘 감싸고 있었다. 왼쪽 유방을 치료하는 경우 심장이 받는 선량은 고선량 영역에서는 WTF, PWT, PEM, STF의 순으로 많은 체적에 선량을 받았으며 낮은 선량 영역에서는 PEM, WTF, PWT, STF의 순이었다. 동측 폐의 선량 역시 마찬가지의 순서를 보였다. Lyman-Kutcher-Burman model에 의한 방사선 폐렴에 대한 NTCP는 개인별 편차가 컸다. 대체로 STF가 가장 작고 PWT가 다음이었으나 PEM와 WTF의 경우는 환자마다 큰 차이를 보였다. 결론: 환자들의 다양한 체형에도 불구하고 IMN를 포함하여 치료하는 경우 PWT가 폐와 심장의 조사선량을 줄이고 IMN에 표적선량을 전달하는데 적합한 것으로 생각된다.

Keywords

References

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