전유방절제술 환자에서 IMRT와 VMAT을 이용한 방사선치료시 선량 분포의 비교

국문 초록 (Abstract)

전유방절제술을 시행하고 방사선치료시 조사야에 흉벽과 IMNs이 포함되어 심장과 동측 폐에 고선량의 방사선이 흡수되어 만성이환율에 영향을 미칠 수 있다. 따라서 본 연구에서는 전유방절제술을 시행한 유방암 환자의 방사선 치료시 IMRT와 VMAT 기법을 이용하여 선량분포양상을 비교하고자 한다. 유방암 진단을 받고 전유방절제술과 방사선 치료를 시행 받은 환자 중 PTV내에 IMNs가 포함되는 10명의 환자를 선택하여 환자의 흉벽조직, SCL, IMNs을 포함하여 각각 IMRT와 VMAT를 이용하여 치료계획을 실시한 후 PTV의 일치성과 심장 및 폐에 입사되는 선량을 서로 비교하고자 하였다. 그 결과 IMRT와 VMAT에서 모두 PTV의 일치성은 동일 양상(p<0.05)을 보였으며, 좌측유방암 환자인 경우 심장의 고선량 영역은 VMAT이 더 적은 체적으로 관찰(p<0.05)되었다. 폐선량의 경우 IMRT 보다 VMAT시 선량이 더 적게 관찰(p<0.05)되었다. IMNs을 포함하여 치료하는 경우 VMAT가 IMRT보다 방사선 치료 효율이 높을 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

Underwent on modified radical mastectomy(MRM) and radiation therapy, it affects increasing rates of chronic morbidity, because of including chest wall and internal mammary nodes(IMNs). It causes the high absorbed dose on heart and ipsilateral lung. Thus in this study, we compared dose distributions through utilizing the intensity modulated radiation therapy(IMRT) and the volumetric modulated arc therapy(VMAT). We selected 10 breast cancer patients at random who took MRM and radiation therapy. Treatment plannings were done by using IMRT and VMAT from each patient ranging supraclavicular lymphnodes(SCL) and IMNs. After that we analysed the planning target volume(PTV)s conformity and absorbed doses on heart and lungs. As a results, PTV conformities were indicated the same patten(p<0.05) in both plans. In case of Lt breast cancer patients, the dose maximum regions of the heart were more lesser in VMAT technique rather than the IMRT(p<0.05). Also, the maximum dose areas of lungs were lesser in VMAT technique rather than the IMRT(p<0.05). Therefore, it would be safe to say that it is more effective way to adapt the VMAT technique than IMRT in such cases like involve IMNs in breast cancer patients.

목차 (Table of Contents)

• 요약
• Abstract
• Ⅰ. 서론
• Ⅱ. 실험대상 및 방법
• Ⅲ. 실험결과
• Ⅳ. 고찰
• Ⅴ. 결론
• 참고문헌

참고문헌 (Reference)

1 문성권, "좌측 유방 방사선치료를 위한 역치료계획의 세기변조방사선치료와 다중빔조사영역치료기법 사이의 포괄적 선량측정 분석" 대한방사선종양학회 28 (28): 39-49, 2010

2 L. M. Chin, "Three-dimensional photon dose distributions with and without lung corrections for tangential breast intact treatments" 17 (17): 1327-1335, 1989

3 B. A. Fraass, "The influence of lung density corrections on treatment planning for primary breast cancer" 14 (14): 179-190, 1988

4 International Commission on Radiation Units and Measurements, "Report 62:Prescribing, Recording and Reporting Photon Beam Therapy" 1999

5 Tomas Kron, "Planning evaluation of radiotherapy for complex lung cancer cases using helical tomotherapy" 49 (49): 3675-3690, 2004

6 Michael T. Milano, "Normal Tissue Tolerance Dose Metrics for Radiation Therapy of Major Organs" 17 (17): 131-140, 2007

7 D. Palma, "New Developments in Arc Radiation Therapy:A Review" 36 (36): 393-399, 2010

8 L. F. Paszat, "Mortality from myocardial infarction after adjuvant radiotherapy for breast cancer in the surveillance, epidemiology, and end-results cancer registries" 16 (16): 2625-2631, 1998

9 M. W. McDonald, "Long-term outcomes of IMRT for breast cancer: a single-institution cohort analysis" 72 (72): 1031-1040, 2008

10 G. Gyenes, "Long-term cardiac morbidity and mortality in a randomized trial of pre-and post operative radiation therapy versus surgery alone in pprimary breast cancer" 48 (48): 185-190, 1998

11 F. Lohr, "Is cardiotoxicity still an issue after breast -conserving surgery and could it be reduced by multifield IMRT?" 185 (185): 222-230, 2009

12 Carmen C. Popescu, "Inverse-planned, dynamic, multi-beam, intensity-modulated radiation therapy (IMRT): A promising technique when target volume is the left breast and internal mammary lymph nodes" 31 (31): 283-291, 2004

13 A. Harsolia, "Intensity-modulated radiotherapy results in significant decrease in clinical toxicities compared with conventional wedge-based breast radiotherapy" 68 (68): 1375-1380, 2007

14 Filip Claus, "Intensity modulated radiation therapy for oropharyngeal and oral cavity tumors: clinical use and experience" 38 (38): 597-604, 2002

15 M. Y. Jung, "Hematological change in mice injected with radiosensitizer and irradiated with highdose radiation" 7 (7): 1136-1140, 2009

16 김영재, "4차원 방사선 치료시 Body Fix의 유용성 평가" 한국콘텐츠학회 13 (13): 419-426, 2013