PURPOSE:We have evaluated thoracic conformation of patients in order to derive a numeric value predictive of an increased dose to left anterior descending coronary artery (LAD), critical structure for the development of late radio induced cardiac morbidity.
METHODS:We have evaluated 91 patients (36-88 years) affected by breast cancer stage I-II (Tis-T1-2 N0-1), undergoing adjuvant radiotherapy with conventional fractionation. For each patient on CT images was measured the distance between the back face of the sternum (manubrium) and the anterior face of body of the corresponding vertebra (a), and the distance measured on the line at 45° between the vertebral body of the same vertebra and the back face of the rib corresponding (b). The a/b ratio showed values between 0.626 and 1.123. We used the median value (0.821) as cut-off to divide the patients in two groups. We calculated in both groups: Volume (Vol) heart, Vol LAD with an expansion of 0.6 mm; Dmean LAD (Gy); Dmax LAD (Gy); V10-V20-V30 (%) LAD and we correlated these values with parametric and non-parametric tests.
RESULTS:The Pearson test has showed a statistically significant correlation between Vol breast and V10, V20, V30 with borderline significance (p = 0.006; p = 0.02; p = 0.05). The data were confirmed by testing non-parametric Kendall (tau = 0.004; tau = 0.015; tau = 0.016) and Spearman (rho = 0.003; rho = 0.016; rho = 0.015). We conducted categorizing into quartiles of breast volume and evaluated the correlation with a/b. We have found a significative correlation (p = 0.01) between small Vol breast (≤660.23 cc) and a/b < 0.0821 and greater Vol breast (>660.23 cc) with a/b > 0.0821. From the evaluation of the distribution of V10 in the two groups taking account of the Dmean ≤5 or >5 significance was found with a/b; Chi square 0.009 (0.01). Values ≤5 were observed in women with a/b < 0.0821. Values >5 in women with a/b > 0.0821.
CONCLUSIONS:The geometric conformity of chest thorax considering a/b and the value of 0.0821 can reveals an important parameter in the selection of patients suitable for radiation therapy on left breast in order to evaluate the risk of late cardiac events. This consideration during treatment planning can change the technique or the set-up allowing the development of a customized plan.
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【Detection of a numeric value predictive of increased dose to left anterior descending coronary artery (LAD) in radiotherapy of breast cancer.].
【检测预测乳腺癌放疗中左前降支冠状动脉（LAD）剂量增加的数值。】
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DOI：10.1186/s40064-016-2399-7文章类型：杂志文章
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目的：我们评估了患者的胸廓结构，以得出预测左前降支冠状动脉（LAD）剂量增加的数值，该数字是晚期放射性诱发的心脏病的关键结构。
方法：我们评估了91例（36-88岁）受乳腺癌I-II期（Tis-T1-2 N0-1）影响的患者，他们接受了常规分流的辅助放疗。对于每位CT图像上的患者，测量胸骨背面（手掌）与相应椎骨的身体前表面之间的距离（a），并在距椎骨的椎体之间45°线上测量的距离相同的椎骨与肋骨的背面相对应（b）。 a / b比显示为0.626至1.123之间的值。我们使用中位数（0.821）作为临界值，将患者分为两组。我们对两组进行了计算：心脏的体积（Vol），扩展的0.6 mm的LAD体积; Dmean LAD（Gy）; Dmax LAD（Gy）; V10-V20-V30（％）LAD，我们将这些值与参数测试和非参数测试相关联。
结果：Pearson检验显示Vol乳腺与V10，V20，V30之间具有统计学显着相关性，具有临界意义（p = 0.006; p = 0.02; p = 0.05）。通过测试非参数Kendall（tau = 0.004; tau = 0.015; tau = 0.016）和Spearman（rho = 0.003; rho = 0.016; rho = 0.015）确认数据。我们对乳房体积的四分位数进行了分类，并评估了与a / b的相关性。我们发现小体积乳房（≤660.23cc）与a / b <0.0821和较大体积乳房（> 660.23 cc）与a / b> 0.0821之间存在显着相关性（p = 0.01）。通过评估Dmean≤5或> 5的显着性，从两组中V10的分布评估中，发现a / b；卡方0.009（0.01）。在a / b <0.0821的女性中观察到的值≤5。 A / b> 0.0821的女性的值> 5。
结论：考虑到a / b和0.0821的值，胸廓的几何一致性可以为选择适合左胸放射治疗的患者选择一个重要参数，以评估晚期心脏事件的风险。治疗计划期间的考虑因素可能会更改技术或设置，从而允许制定自定义计划。
方法：我们评估了91例（36-88岁）受乳腺癌I-II期（Tis-T1-2 N0-1）影响的患者，他们接受了常规分流的辅助放疗。对于每位CT图像上的患者，测量胸骨背面（手掌）与相应椎骨的身体前表面之间的距离（a），并在距椎骨的椎体之间45°线上测量的距离相同的椎骨与肋骨的背面相对应（b）。 a / b比显示为0.626至1.123之间的值。我们使用中位数（0.821）作为临界值，将患者分为两组。我们对两组进行了计算：心脏的体积（Vol），扩展的0.6 mm的LAD体积; Dmean LAD（Gy）; Dmax LAD（Gy）; V10-V20-V30（％）LAD，我们将这些值与参数测试和非参数测试相关联。
结果：Pearson检验显示Vol乳腺与V10，V20，V30之间具有统计学显着相关性，具有临界意义（p = 0.006; p = 0.02; p = 0.05）。通过测试非参数Kendall（tau = 0.004; tau = 0.015; tau = 0.016）和Spearman（rho = 0.003; rho = 0.016; rho = 0.015）确认数据。我们对乳房体积的四分位数进行了分类，并评估了与a / b的相关性。我们发现小体积乳房（≤660.23cc）与a / b <0.0821和较大体积乳房（> 660.23 cc）与a / b> 0.0821之间存在显着相关性（p = 0.01）。通过评估Dmean≤5或> 5的显着性，从两组中V10的分布评估中，发现a / b；卡方0.009（0.01）。在a / b <0.0821的女性中观察到的值≤5。 A / b> 0.0821的女性的值> 5。
结论：考虑到a / b和0.0821的值，胸廓的几何一致性可以为选择适合左胸放射治疗的患者选择一个重要参数，以评估晚期心脏事件的风险。治疗计划期间的考虑因素可能会更改技术或设置，从而允许制定自定义计划。
