Background: Multimodality is required for the treatment of breast cancer. Surgery, radiation (RT), and systemic therapy were traditionally used. Pharmacotherapy includes different drug mechanisms, such as chemotherapy, hormone therapy, and targeted therapies, alone or in combination with radiotherapy. While radiation offers numerous benefits, it also has certain harmful risks. such as cardiac and pulmonary toxicity, lymphedema, and secondary cancer. Modern radiation techniques have been developed to reduce organs at risk (OAR) doses. Materials and Methods: This study is a prospective feasibility trial conducted at the Fayium Oncology Center on patients with left breast cancer receiving adjuvant locoregional radiotherapy after either breast conservative surgery (BCS) or modified radical mastectomy (MRM). This study aimed to assess the proportion of patients who are fit both physically and intellectually to undergo breast radiotherapy using the deep inspiratory breath-holding (DIBH) technique, comparing different dosimetric outcomes between the 3D dimensional conformal with DIBH and 4D-CT IMRT plans of the same patient. Results: D95 of the clinical target volume (CTV) of the target is significantly higher in the 3D DIBH plan than in the IMRT plan, with an average of 90.812% vs. 86.944%. The dosimetry of the mean heart dose (MHD) in the 4D-CT IMRT plan was significantly lower than in the 3D conformal with the DIBH plan (2.6224 vs. 4.056 Gy,p< 0.0064), and no significant difference between the two plans regarding mean left anterior descending artery (LAD) (14.696 vs. 13.492 Gy,p< 0.58), maximum LAD (39.9 vs. 43.5 Gy,p< 0.35), and V20 of the ipsilateral lung (18.66% vs. 16.306%,p< 0.88) was observed. Internal mammary chain (IMC) irradiation was better in the 4D-CT IMRT plan. Conclusions: Radiotherapy of the breast and chest wall with the 4D-CT IMRT technique appears not to be inferior to the 3D conformal with the DIBH technique and can be used as an alternative to the 3D conformal with the DIBH technique in patients meeting the exclusion criteria for performing the DIBH maneuver concerning coverage to target volumes or unacceptably high doses to OAR.
背景：乳腺癌的治疗需要多学科综合手段。传统上采用手术、放疗和全身性治疗。药物治疗涵盖不同作用机制的药物，包括化疗、激素治疗和靶向治疗，可单独或与放疗联合应用。尽管放疗具有诸多益处，但也存在一定风险，如心脏和肺毒性、淋巴水肿及继发性癌症。现代放疗技术已发展出降低危及器官受照剂量的方法。 材料与方法：本研究为前瞻性可行性试验，在法尤姆肿瘤中心开展，研究对象为接受保乳手术或改良根治性乳房切除术后需行辅助性局部区域放疗的左乳腺癌患者。研究旨在评估适合采用深吸气屏气技术接受乳腺放疗的患者比例，并比较同一患者采用三维适形联合深吸气屏气技术与四维CT调强放疗计划在剂量学参数上的差异。 结果：三维深吸气屏气计划中临床靶区D95显著高于调强放疗计划（平均值分别为90.812% vs. 86.944%）。四维CT调强放疗计划的平均心脏剂量显著低于三维适形联合深吸气屏气计划（2.6224 vs. 4.056 Gy，p<0.0064）。两种计划在左前降支平均剂量（14.696 vs. 13.492 Gy，p<0.58）、左前降支最大剂量（39.9 vs. 43.5 Gy，p<0.35）及同侧肺V20（18.66% vs. 16.306%，p<0.88）方面无显著差异。四维CT调强放疗计划在内乳链照射方面表现更优。 结论：采用四维CT调强放疗技术进行乳腺及胸壁放疗，在靶区覆盖或危及器官剂量过高方面不劣于三维适形联合深吸气屏气技术。对于因不符合深吸气屏气操作排除标准而导致靶区覆盖不足或危及器官受照剂量过高的患者，四维CT调强放疗可作为三维适形联合深吸气屏气技术的替代方案。
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