自主呼吸控制在乳腺癌术后放疗中的应用研究  

Active breathing control in postoperative radiotherapy for breast cancer

作　　者：姚春萍[1] 于金明[1] 李建彬[1] 卢洁[1] 王学涛[1] 刘娟[1] 刘同海[1] 付政[1] 余宁莎[1] 

机构地区：[1]山东省肿瘤医院放疗科,济南250117

出　　处：《中华放射肿瘤学杂志》2006年第3期211-214,共4页Chinese Journal of Radiation Oncology

摘　　要：目的探讨自主呼吸控制(ABC)技术在乳腺癌术后放疗中的意义。方法对22例行保乳术的早期乳腺癌患者(10例左侧,12例右侧)行术后全乳放疗并配合使用ABC技术。对每例患者在自由呼吸(FB)和75%适度深吸气(mDIBH)状态下分别行CT扫描。治疗计划系统设计优化放疗计划,每例患者做2个计划,处方剂量1.8Gy/次,25次。比较各计划全肺平均受量(MLD)、全肺接受20Gy的体积(V20)、患侧肺V20、左侧乳腺癌患者心脏V30和心脏平均受量(Dmean)等参数。结果22例患者患侧肺V20,FB时平均为17.0%,mDIBH时平均为16.2%,降低0.8%(t=3.63,P=0.002);FB时双肺V20平均为8.7%,mDIBH时平均为8.0%,降低0.6%(t=2.78,P=0.011)。10例左侧患者心脏V30,FB时平均为6.1%,mDIBH时平均为3.8%,降低2.3%(t=6.50,P<0.01);心脏Dmean由449.58cGy降为332.79cGy(t=5.94,P<0.01)。结论乳腺癌术后全乳切线放疗中配合ABC技术使用mDIBH方法控制呼吸不但可减少呼吸运动对乳腺靶区的影响,而且可减少肺和心脏受照体积和剂量,从而大大减轻了对肺和心脏的放射损伤。Objective To study the value of active breathing control（ABC） in postoperative radiotherapy for breast cancer. Methods Having breast conservative surgery, 22 early stage breast cancer patients（left-sided lesion 10, right-sided 12 ） were treated by whole breast radiotherapy with active breathing control（ABC） technique. All patients had CT scans at standard free breathing（FB） and 75% moderate deep inspiration breath holding （mDIBH）position. For each scan, with optimized treatment plan designed with conformal tangential field, the prescribed dose was 1.8 Gy× 25 fractions. For FB and ABC plan, the mean lung dose（MLD）, percentage of both ltmgs receiving 20 Gy（V20） ,ipsilateral lung V20,the percentage of heart receiving 30 Gy（V30） were compared; for left-sided breast cancer patients, the mean dose of heart（Dmean） were also compared. Results For the whole group, the ipsilateral lung V20 was 17.0 % and 16.2 % at FB and mDIBH, with a decrease of 0.8 % （ t = 3.63, P =0.002）; both ltmg V20 was 8.7% and 8.0% at FB and mDIBH,with a decrease of 0.6%（t = 2.78, P= 0.011）. For 10 left-sided patients, the heart V30 was 6.1% and 3.8% at FB and mDIBH, with a decrease of 2.3 % （ t = 6.50, P 〈 0.01 ） ; The heart Dmean decreased from 449.58 cGy to 332.79 cGy（ t = 5.94, P 〈 0.01 ）. Conclusion Moderate Deep Inspiration Breath Holding （mDIBH） not only decreases the impact of respiratory motion on breast target during postoperative whole breast radiotherapy, but also significantly reduces the lung and heart irradiated volume and dose, thus lessening the radiation injury to lung and heart.

关 键 词：乳腺肿瘤/放射疗法 呼吸运动 自主呼吸控制 

分 类 号：R737.9[医药卫生—肿瘤] R563.8[医药卫生—临床医学]