保乳术后自主呼吸控制部分乳腺外照射靶区位移的研究  

Study on the target movement in external-beam partial breast irradiation with active breathing control after breast-conserving surgery

作　　者：李建彬[1] 张琳[1] 卢洁[2] 马志芳[1] 王永胜[3] 梁超前[1] 于金明[1] 刘娟[2] 

机构地区：[1]山东省肿瘤医院放疗一科,济南250117 [2]山东省肿瘤医院物理室,济南250117 [3]山东省肿瘤医院乳腺外科,济南250117

出　　处：《中华肿瘤杂志》2008年第3期207-210,共4页Chinese Journal of Oncology

基　　金：山东省科技计划资助项目（012130141）

摘　　要：目的探讨保乳术后自主呼吸控制（ABC）部分乳腺外照射（EB—PBI）不同呼吸状态问以及单次放疗中和分次放疗间银夹和术腔的位移。方法对25例Ⅰ、Ⅱ期行保乳术的乳腺癌术后患者配合ABC装置进行放疗前CT模拟定位，每例患者均获取自主呼吸、适度深吸气控制（mDIBH）和深呼气末（DEBH）共3种呼吸状态的5套CT图像，并于10～15d后重复CT模拟定位。在Pinnacle’治疗计划系统中，由同一名医生，在每例患者的CT图像上，分别进行相应的术腔勾画和银夹标记，分析术腔和银夹的位移情况。结果CT扫描首次出现银夹的感兴趣点（POI）坐标在mDIBH和DEBH两个呼吸状态之间的位移在X、Y、Z3个方向分别为0．22、1．27和0．50cm，术腔POI坐标位移分别为0．10、1．08和0．50cm，X、Y、Z3个方向间差异均有统计学意义。全部银夹所构成几何体的POI坐标在单次放疗中不同时段mDIBH呼吸状态的位移，在X、Y、Z3个方向分别为0．09、0．14和0．25cm，术腔POI坐标位移分别为0．15、0．17和0．25cm，X、Y、Z3个方向间差异均无统计学意义。全部银夹所构成几何体的POI坐标在分次放疗间同一呼吸状态的位移，在X、Y、Z3个方向分别为0．68、0．37和0．50cm，术腔POI坐标位移分别为0．66、0．45和0．75cm，X、Y、Z3个方向间差异均无统计学意义。结论不同呼吸状态下实施EB—PBI时，计划靶区外扩边界应该是不同的，自由呼吸时不同轴向的外扩边界也应该是不同的，而ABC辅助mDIBH状态下，各个轴向的外扩边界可以是相同的。Objective To explore the displacement of surgical clip and cavity during different respiratory status, intrafraction and interfraction for the patients treated by external-beam partial breast irradiation （EB-PBI） assisted by active breathing control （ABC） device after breast-conserving surgery. Methods After breast-conserving surgery, twenty-five patients with stage Ⅰ/Ⅱ breast cancer who was identified to be feasible for EB-PBI underwent CT-simulation positioning assisted with ABC device. Five series of CT images were done during three respiratory status, which included one series of images during free breathing status （FB）, two series of images during moderate deep inspiration breath hold （mDIBH）, two series of images during deep expiration breath hold （DEBH） at 75% maximum inspiration capacity, and all of the five series of images were transferred to ADAC Pinnacle3 treatment planning system. This procedure was repeated after 10 ～ 15 days. The targets were delineated and the first appeared clips were marked by the same radiotherapist on the CT images in mDIBH and DEBH status from the first CT simulation positioning to analyze the displacement of the targets produced by respiratory status. The targets were also delineated and all of the clips were marked by the same radiotherapist on another two series of CT images during mDIBH from the first and repeated CT-simulation positioning for analyzing the intrafraction and interfraction movement of cavity and clips, respectively. Results There was a significant difference between mDIBH and DEBH in the movement of the point of interest （POI） of the first appeared clip in the directions of X（0.22 cm）, Y （1.27 cm）and Z axis（0.50 cm） （X^2 =9.558, P =0.008） ; and this was also found to be present in the movement of POI of the cavity in the directions of X （ 0.10 cm）, Y （ 1.08 cm） and Z axis （ 0.50 cm） （X^2 = 20.44,P 〈 0.01 ）. Regardless of the clip and the cavity, the movement extent along the direction of Y axi

关 键 词：乳腺肿瘤 部分乳腺外照射 自主呼吸控制 靶区位移 银夹位移 

分 类 号：R686[医药卫生—骨科学]