Effect of Different Surgical Types on the Accuracy of Radiotherapy for Breast Cancer
Objective To study the effect of three types of surgery on the accuracy of radiotherapy for breast cancer:modified radical mastectomy(radical mastectomy),early breast conserving surgery(breast conserving surgery),and prosthesis implantation,and to develop personalized radiotherapy programs for patients with different types of surgery.Methods A total of 37 patients with breast cancer undergoing VMAT in the First Affiliated Hospital of Xiamen University from May 2023 to July 2023 were randomly selected and retrospectively analyzed,including 13 patients with radical mastectomy,11 patients with breast conservation,and 13 patients with prosthesis implantation.In addition to the first CBCT reduction,each patient will collect CBCT every five days before treatment and register it with the positioning image,recording the error values in three directions:ventral dorsum(VRT),head and foot(LNG),and left and right(LAT).A total of 150 sets of error data were collected,including 61 groups for radical treatment,38 groups for breast preservation,and 51 groups for prosthesis implantation,and the error was analyzed.Results The positioning errors in the three-dimensional direction of the radical treatment group were:VRT:[-1.80(-3.20,-0.20)]mm,LNG:[-2.20(1.10,3.05)]mm,LAT:[-3.30(-1.10,1.65)]mm,the positioning errors in the three-dimensional direction of the breast conserving group were:[-0.20(-1.03,1.03)]mm,LNG[1.40(-2.20,3.00)]mm,LAT[0.15(-3.05,2.90)]mm,and the positioning errors in the three-dimensional direction of the implant group were:VRT[-1.00(-3.00,0.70)mm],LNG[-1.00(-3.00,1.80)mm],LAT[0(-2.00,2.80)mm],respectively.Kruskal-Wallis test and post HOC multiple comparisons were conducted on the three sets of data,and it was found that the radical treatment group and breast conserving group had a statistically significant difference of in the VRT direction(P<0.05),while in the LNG and LAT directions,there was no statistically significant difference in the three sets of data(P>0.05).The planning target volume(PTV)boundaries in the three-dimensional direction for three different surgical types were 4.18,6.19,7.52 mm in the radical group,4.71,6.53,8.01 mm in the breast conserving group,and 6.17,7.53,6.29 mm in the implant group.Conclusion Different types of surgery have different effects on the accuracy of radiotherapy for breast cancer.In the VRT direction,the positioning error of the radical surgery group is greater than that of the breast conserving group.According to different types of surgery,the fixation methods can be personalized to improve the positioning accuracy of patients.In addition,each tumor center can calculate the suitable PTV extension range for their own center based on different surgical types to provide advice to clinical doctors.
breast cancersurgical typeradiotherapypositioning errorPTV boundaryrotational intensity modulation therapy
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