표면위치표지자를 적용한 정위적 부분유방방사선치료의 유용성 평가

Evaluation of usefulness for Stereotactic Partial Breast Irradiation(S-PBI) by using Surface Fiducial Marker

  • 김종열 (연세암병원 방사선종양학과) ;
  • 정동민 (연세암병원 방사선종양학과) ;
  • 김세영 (연세암병원 방사선종양학과) ;
  • 유현종 (연세암병원 방사선종양학과) ;
  • 최정환 (연세암병원 방사선종양학과) ;
  • 박효국 (연세암병원 방사선종양학과) ;
  • 백종걸 (연세암병원 방사선종양학과) ;
  • 이상규 (연세암병원 방사선종양학과) ;
  • 조정희 (연세암병원 방사선종양학과)
  • Kim, JongYeol (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Jung, DongMin (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Kim, SeYoung (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Yoo, HyunJong (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Choi, JungHoan (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Park, HyoKuk (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Baek, JongGeol (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Lee, SangKyu (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Cho, JeongHee (Department of Radiation Oncology, Yonsei Cancer Center)
  • 발행 : 2021.12.31

초록

목 적: 사이버나이프를 이용한 정위적 부분유방방사선치료(Stereotactic Partial Breast Irradiation) 시 기존의 침습적인 위치표지자(Fiducial Marker) 삽입 방식이 아닌 비침습방식에 대한 유용성을 평가 하고자 한다. 대상 및 방법: 본 연구를 위한 영상 중심(Imaging Center)의 일치도는 2D모의치료기와 사이버나이프의 양사방향(Both oblique, 45 °, 315 °) 영상 획득 후 다이스 유사 계수를 통해 정량적으로 평가하였다. 표면위치표지자의 위치 재현성은 본원 프로토콜을 기반으로 ATOM Phantom 표면에 금 재질의 위치표지자 8개를 부착하고 2D모의치료와 치료계획, 사이버나이프 영상을 분석하여 평가 하였다. 결 과: 영상 중심의 일치도 평가결과는 양사방향(45 °, 315 °)에서 각각 0.87, 0.9 였다. 표면위치표지자의 재현성 평가 결과 좌측 유방은 수평수직방향 Superior/Inferior 0.3 mm, Left/Right -0.3 mm, Anterior/Posterior 0.4 mm, 회전 방향 Roll 0.3 °, Pitch 0.2 °, Yaw 0.4 ° 로 나타났다. 우측 유방은 수평수직방향 Superior/Inferior -0.1 mm, Left/Right -0.1 mm, Anterior/Posterior -0.1 mm 회전 방향 Roll 0.2 °, Pitch 0.1 °, Yaw 0.1 ° 로 나타났다. 결 론: 사이버나이프를 이용한 정위적 부분유방암방사선치료 시 표면위치표지자의 비침습 트로토콜을 기반으로 통증 및 감염 등의 예방과 전처치 시간을 줄이고 환자의 경제적 부담을 경감 할 수 있었으며, 영상 중심의 높은 일치도 및 위치표지자의 재현성을 바탕으로 치료에 유용할 것으로 사료된다.

Purpose: The goal of this study is to evaluate usefulness of noninvasive method instead of previous inserting Fiducial Marker Method when performing Stereotactic Partial Breast Irradiation in CyberKnife. Material and methods: For consistency of Imaging Center, we evaluated both oblique images at angle 45 and 315 acquired from 2D Simulator and CyberKnife quantitatively through dice similarity coefficient. Also, location reproducibility of Surface Fiducial Marker was analyzed from 2D Simulator, treatment plans and CyberKinfe images by using 8 Fiducial Markers made of gold attached to ATOM Phantom based on our institution's protocols. Results: The results of the estimated consistency were 0.87 and 0.9 at the oblique angle 45 and 315, respectively. For location consistency of Surface Fiducial Markers, values of horizontal vertical direction of left breast were Superior/Inferior 0.3 mm, Left/Right -0.3 mm, Anterior/Posterior 0.4 mm, and the values of rotational direction were Roll 0.3 °, Pitch 0.2 °, Yaw 0.4 °. The values of horizontal vertical direction of right breast were Superior/Inferior -0.1 mm, Left/Right -0.1 mm, Anterior/Posterior -0.1 mm, and the values of rotational direction were Roll 0.2°, Pitch 0.1°, Yaw 0.1°. Conclusions: We expect that the protocols used by Surface Fiducial Markers when performing Stereotactic Partial Breast Irradiation in CyberKnife will provide protection from pain and cut expenses for treatment and reduce treatment errors and make treatment more accurate by suggesting treatment protocols based on high consistency of Imaging Center and reproducibility of Fiducial Markers.

키워드

참고문헌

  1. Hong S, Won YJ, Park YR, et al.: Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2017. Cancer Res Treat 2020;52:335-350 https://doi.org/10.4143/crt.2020.206
  2. Kim KJ, Suh CO. Partial breast cancer (PBI). J Korean Breast Cancer Soc 2004;7:65-71 https://doi.org/10.4048/jkbcs.2004.7.2.65
  3. Strnad V, Ott OJ, Hildebrandt G, et al.: 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet 2016;387(10015):229-38 https://doi.org/10.1016/S0140-6736(15)00471-7
  4. Herskind C, Wenz F.: Radiobiological comparison of hypofractionated accelerated partial-breast irradiation (APBI) and single-dose intraoperative radiotherapy (IORT) with 50-kV X-rays. Strahlenther Onkol 2010;186:444-451 https://doi.org/10.1007/s00066-010-2147-9
  5. Baglan KL, Sharpe MB, Jaffray D, et al.: Accelerated partial breast irradiation using 3D conformal radiation therapy (3D-CRT). Int J Radiat Oncol Biol Phys 2003;55:02-311
  6. Livi L, Meattini I, Marrazzo L, et al.: Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer 2015;51(4):451-63 https://doi.org/10.1016/j.ejca.2014.12.013
  7. La Rocca E, Lozza L, D'Ippolito E, et al.: VMAT partial-breast irradiation: acute toxicity of hypofractionated schedules of 30 Gy in five daily fractions. Clinical and Translational Oncology 2020;22.10:1802-1808 https://doi.org/10.1007/s12094-020-02319-5
  8. Hui SK, Das RK, Kapatoes J, et al.: Helical tomotherapy as a means of delivering accelerated partial breast irradiation. Technol Cancer Res Treat 2004;3(6):639-46 https://doi.org/10.1177/153303460400300614
  9. Chang JH, Lee NK, Kim JY, et al.: Phase II trial of proton beam accelerated partial breast irradiation in breast cancer. Radiother Oncol 2013;108:209-214 https://doi.org/10.1016/j.radonc.2013.06.008
  10. Vermeulen SS, Haas JA.: CyberKnife stereotactic body radiotherapy and CyberKnife accelerated partial breast irradiation for the treatment of early breast cancer. Translational Cancer Research 2014;3(4):295-302
  11. Obayomi-Davies O, Kole TP, Oppong B, et al.: Stereotactic Accelerated Partial Breast Irradiation for Early-Stage Breast Cancer: Rationale, Feasibility, and Early Experience Using the CyberKnife Radiosurgery Delivery Platform. Front Oncol 2016;6:129
  12. Lozza L, Fariselli L, Sandri M, et al.: Partial breast irradiation with CyberKnife after breast conserving surgery: a pilot study in early breast cancer. Radiat Oncol 2018;13(1):49 https://doi.org/10.1186/s13014-018-0991-4
  13. Rault E, Lacornerie T, Dang HP, et al.: Accelerated partial breast irradiation using robotic radiotherapy: a dosimetric comparison with tomotherapy and three-dimensional conformal radiotherapy. Radiat Oncol 2016;11:29 https://doi.org/10.1186/s13014-016-0607-9
  14. Lee CY, Kim WC, Kim HJ, et al.: Dosimetric Plan Comparison of Accelerated Partial Breast Irradiation (APBI) Using CyberKnife. Prog Med Phys 2018;29(2):73-80 https://doi.org/10.14316/pmp.2018.29.2.73
  15. Lee WH, "Developing a Novel High-precision Radiotherapy for Low Risk Early-stage Breast Cancer in Korean Women - Stereotactic Partial Breast Irradiation with CyberKnife M6." Dissertation, Seoul The Graduate School Yonsei University,2019.
  16. Correa C, Harris EE, Leonardi MC, et al.: Accelerated Partial Breast Irradiation: Update of an ASTRO Evidence-Based Consensus Statement Conflict of Interest Disclosure Statement. Pract Radiat Oncol 2017;1-26
  17. Rahimi A, Thomas K, Spangler A, et al.: Preliminary Results of a Phase 1 Dose-Escalation Trial for Early-Stage Breast Cancer Using 5-Fraction Stereotactic Body Radiation Therapy for Partial-Breast Irradiation. Int J Radiat Oncol Biol Phys 2017;98(1):196-205 https://doi.org/10.1016/j.ijrobp.2017.01.020
  18. Seiler S, Rahimi A, Choudhery S, et al.: Ultrasound-Guided Placement of Gold Fiducial Markers for Stereotactic Partial-Breast Irradiation. AJR Am J Roentgenol 2016;207(3):685-8 https://doi.org/10.2214/AJR.15.14771
  19. Kim JH, Hong SS, Kim JH, et al.: Safety and efficacy of ultrasound-guided Fiducial Marker implantation for CyberKnife radiation therapy. Korean J Radiol 2012;13(3):307-13 https://doi.org/10.3348/kjr.2012.13.3.307
  20. Hemmatazad H, Schmidhalter D, Elicin O, et al.: Herrmann E. Skin surface markers for stereotactic body radiation therapy of sternal metastasis. Rep Pract Oncol Radiother 2019;24(4):322-4 https://doi.org/10.1016/j.rpor.2019.05.005
  21. Accuray Inc. Treatment Delivery In. CyberKnife Treatment Delivery Manual. 2014;V10.x:5-21
  22. Dieterich S, Gibbs IC.: The CyberKnife in clinical use: current roles, future expectations. Front Radiat Ther Oncol 2011;43:181-94 https://doi.org/10.1159/000322423
  23. Kelly HZ, Simon KW, Clare MCT, et al.: Statistical validation of image segmentation quality based on a spatial overlap index1: scientific reports. Academic radiology 2004;11.2:178-189 https://doi.org/10.1016/S1076-6332(03)00671-8
  24. Accuray Inc. Treatment Delivery In. CyberKnife Treatment Delivery Manual. 2014;V10.x:7-58,59