충북의대학술지 Chungbuk Med. J. Vol. 26. No. 1. 1~ 초기유방암환자에서조사야내조사야전유방방사선치료의 선량분포특성 김원동 * 책임저자 : 김원동, 충북청주시서원구충대로 1, 충북대학교의과대학방사선종양학교실, 의학연구소 (28644),

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1 충북의대학술지 Chungbuk Med. J. Vol. 26. No. 1. 1~ 초기유방암환자에서조사야내조사야전유방방사선치료의 선량분포특성 김원동 * 책임저자 : 김원동, 충북청주시서원구충대로 1, 충북대학교의과대학방사선종양학교실, 의학연구소 (28644), wdkim3@chungbuk.ac.kr (Tel: , Fax: ) * 이논문은 2015 년도충북대학교병원임상연구비에의하여연구되었음. (This work was supported by the clinical research grant of the Chungbuk National University Hospital in 2015) - 1 -

2 Won Dong Kim - 2 -

b1-2) In FIF, initial calculation of two equally weighted open tangential field displayed under and over dosage volume.

3 Dosimetric Characteristics of FIF Whole Breast Radiotherapy a) b1) b2) Fig. 1. Beam arrangement of 3DCRT and FIF. a) In 3DCRT, physical wedge filter were used on both breast side to improve dose homogeneity. b1-2) In FIF, initial calculation of two equally weighted open tangential field displayed under and over dosage volume. Two or three subfields configured by multileaf collimator were introduced to reduce hot spot volume and were combined with main open field as one portal

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5 Dosimetric Characteristics of FIF Whole Breast Radiotherapy Table 1. Planning target volume(ptv) coverage(% value) between 3DCRT and FIF Table 2. Organ at risk(oar) sparing(% value) between 3DCRT and FIF - 5 -

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7 Dosimetric Characteristics of FIF Whole Breast Radiotherapy 1. Morganti AG, Cilla S, de Gaetano A, Panunzi S, Digesù C, Macchia G, et al. Forward planned intensity modulated radiotherapy (IMRT) for whole breast postoperative radiotherapy. Is it useful? When? J Appl Clin Med Phys 2011;12(2): Yavas G, Yavas C, Acar H. Dosimetric comparison of whole breast radiotherapy using field in field and conformal radiotherapy techniques in early stage breast cancer. Iran J Radiat Res 2012;10(3-4): Morganti AG, Cilla S, Valentini V, Digesu C, Macchia G, Deodato F, et al. Phase I-II studies on accelerated IMRT in breast carcinoma: technical comparison and acute toxicity in 332 patients. Radiother Oncol 2009;90(1): Neal AJ, Torr M, Helyer S, Yarnold JR. Correlation of breast dose heterogeneity with breast size using 3D CT planning and dose volume histograms. Radiother Oncol 1995;34(3): Madu CN, Quint DJ, Normolle DP, Marsh RB, Wang EY, Pierce LJ. Definition of the supraclavicular and infraclavicular nodes: implications for three-dimensional CT-based conformal radiotherapy. Radiology 2001;221(2): International Commission on Radiation Units and Measurements (ICRU). Prescribing, recording, and reporting photon beam therapy, IRCU Report 62. Bethesda, MD: ICRU Publications; Ahnesjöo A, Saxner M, Trepp A. A pencil beam model for photon dose calculation. Med Phys 1992;19(2): Mihai A, Rakovitch E, Sixel K, Woo T, Cardoso M, Bell C, et al. Inverse vs. forward breast IMRT planning. Med Dosim 2005;30(3): Pignol J, Olivotto I, Rakovitch E, Gardner S, Ackerman I, Sixel K, et al. Phase III randomized study of intensity modulated radiation therapy versus standard wedging technique for adjuvant breast radiotherapy [Abstract]. Int J Radiat Oncol Biol Phys 2006;66(3 Suppl.):S Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol 2007;82(3): Deutsch M, Bhatnagar AK, Heron DE, Shogan JE, LaLonde R, Huq MS, et al. Analysis of acute toxicity for patients with breast cancer treated with intensity modulated radiation therapy (IMRT)]. Int J Radiat Oncol Biol Phys 2005;63(1 Suppl.):S Dogan N, Cuttino L, Lloyd R, Bump EA, Arthur DW. Optimized dose coverage of regional lymph nodes in breast cancer: the role of intensity-modulated radiotherapy. Int J - 7 -

8 Won Dong Kim Radiat Oncol Biol Phys 2007;68(4): Cho BC, Schwarz M, Mijnheer BJ, Bartelink H. Simplified intensity-modulated radiotherapy using pre-defined segments to reduce cardiac complications in left-sided breast cancer. Radiother Oncol 2004;70(3): Cho BC, Hurkmans CW, Damen EM, Zijp LJ, Mijnheer BJ. Intensity modulated versus non-intensity modulated radiotherapy in the treatment of the left breast and upper internal mammary lymph node chain: a comparative planning study. Radiother Oncol 2002;62(2): Coon AB, Ladsaria S, Kirk M, Shah A, Chen S, Strauss J, et al. Multifield IMRT planning reduces cardiac and left ventricle radiation doses in left-sided breast cancer patients with unfavorable cardiac anatomy [Abstract]. Int J Radiation Oncology Biol Phys 2007;69(3 Suppl.):S

9 Dosimetric Characteristics of FIF Whole Breast Radiotherapy Dosimetric Characteristics of Field in Field Whole Breast Radiotherapy in Early Stage Breast Cancer Won Dong Kim Purpose : The purpose of this study was to compare field in field technique (FIF) with 3D conformal radiation therapy (3DCRT) dosimetrically for early stage breast cancer in Korea and evaluate the clinical applicability of FIF. Materials and Methods : For 5 left-side breast cancer patients who received breast-conserving surgery, FIF plans and 3DCRT plans were made for whole breast radiotherapy and cumulative dose-volume histograms (DVH) were produced. Two plans were compared in terms of Dmax, Dmin, Dmean, V 95%, V 105% of planning target volume (PTV), Dmax, Dmean, V 80%, V 90% of ipsilateral lung/heart, and dose homogeneity index (DHI)/conformity index (CI). Results : With FIF technique, the maximum dose of the PTV was significantly lower (108.0% vs 115.5%) and the minimum dose higher (76.3% vs 66.4%). V 105% of FIF was lower than that of 3DCRT (6.5% vs 7.6%) but it did not translate into statistical significance. There were no differences of Dmean, V 95% between two techniques. The strong favor of FIF was showed in the aspect of DHI (1.13 vs 1.22). Dmax, Dmean, V 80%, V 90% of ipsilateral lung and heart with the FIF plan slightly decreased with no significance. Conclusion : The FIF technique revealed better dose distribution in terms of Dmax, Dmin, DHI of PTV and tendency of decrease of the Dmax, Dmean, V 80%, V 90% of ipsilateral lung and heart. The FIF technique seems to induce the improvement of cosmetic effect and reduce complication of organ at risk. * Corresponding Author: Won Dong Kim, Department of Radiation Oncology, College of Medicine and Medical Research Institute, Chungbuk National University, 1 Chungdae-Ro, Seowon-Gu, Cheongju, Chungbuk 28644, Korea, wdkim3@chungbuk.ac.kr (Tel : , Fax : ) - 9 -

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( )Jkstro011.hwp 비인강암의방사선치료결과및생존율에관한예후인자분석 2005 2 1 2005 3 28. :, Tel: 053)250-7665, Fax: 053)250-7984 E-mail: jhkim@dsmc.or.kr 정영연외 2 인 : 비인강암의예후인자분석 정영연외 2 인 : 비인강암의예후인자분석 Carcinoma of the nasopharynx treated by radiotherapy