乳腺癌改良根治术后胸壁和区域淋巴引流区整体化调强放疗剂量学与不良反应分析  

Irradiation of the chest wall and regional nodes as an integrated volume with IMRT for breast cancer after mastectomy： from dosimetry to clinical side-effects

作　　者：马金利[1] 李炯雁[1] 朱传营[1] 陈剑[1] 曹璐[1] 谢耩[1] 蔡钢[1] 俞晓立[1] 章真[1] 郭小毛[1] 陈佳艺[1] 

机构地区：[1]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院放疗科,上海200032

出　　处：《中华放射肿瘤学杂志》2012年第1期47-51,共5页Chinese Journal of Radiation Oncology

基　　金：上海市自然科学基金（10ZRl406700）

摘　　要：目的探讨乳腺癌改良根治术后胸壁和区域淋巴引流区整体化调强放疗（IMRT）技术的剂量学特点，并观察照射后的急性不良反应。方法对75例乳腺癌患者（左侧乳腺癌41例）以治疗位行计划CT扫描，在CT上将胸壁和锁骨上淋巴引流区加或不加内乳区作为整体勾画。针对整个靶区整体或分段设计IMRT计划，处方剂量50Gy至少包绕90％计划靶体积（PTV），PTV包含内乳区者31例。用靶区和正常组织体积-剂量评价治疗计划，并观察计划实施后的急性不良反应。整体计划与分段计划的剂量学参数比较行成组t检验。结果全组患者均完成计划设计和放疗，PTV适形指数、均匀指数分别为1．43、0．14，PTV包含内乳区者均匀指数较高，110％处方剂量胛V体积均〈5％，正常组织实际剂量均未超出限值。整体计划（55例）与分段计划（20例）比较，其Dmax、Dmean、Vlfl7％和V110％均不同（t=2．19-2．53，P=0．013-0．031）。32例发生≥2级皮炎，其中2级22例、3级10例；发生部位以腋窝前皱褶最为常见，多数发生于放疗后1—2周。仅2例发生2级肺炎。结论胸壁和区域淋巴引流区整体化IMRT技术剂量学上可行，急性不良反应多数患者可耐受。Objective To discuss dosimetric characteristics of an intensity-modulated radiotherapy （IMRT） technique for treating the chest wall and regional nodes as an integrated volume after modified radical mastectomy （MRM） , and observe acute side-effects following irradiation. Methods From June 2009 to August 2010, 75 patients were randomly enrolled. Of these, 41 had left-sided breast cancer. Each eligible patient had a planning CT in treatment position, on which the chest wall, supraclavicular, and infraclavicular nodes, ＋/-internal mammary region, were contoured as an integrated volume. A multi-beam IMRT plan was designed with the target either as a whole or two segments divided at below the clavicle head. A dose of 50 Gy in 25 fractions was prescribed to cover at least 90% of the PTV. Internal mammary region was included in 31 cases. Dose volume histograms were used to evaluate the IMRT plans. The acute side effects were followed up regularly during and after irradiation. The independent two-sample t-test was used to compare the dosimetric parameters between integrated and segmented plans. Results Planning design was completed for all patients, including 55 integrated and 20 segmented plans, with median number of beams of 8. The conformity index and homogeneity index was 1.43 ＋ 0. 15 and 0.14 ± 0. 02, respectively. Patients with internal mammary region included in PTV had higher homogeneity index PT. The percent volume of PTV receiving 〉 110% prescription dose was 〈 5%. None of the close constraints to normal structures was violated. There were statistically significant differences in the means of dosimetric parameters of PTV, such as D D V107%, and Vl10%, between integrated and segmented plans （t = 2. 19 - 2. 53, P = 0. 013 -0. 031 ） . ≥ grade 2 radiation dermatitis was identified in 3 2 patients （ grade 2 in 2 2 patients , grade 3 in 10 patients ） , mostly occurred within 1 - 2 weeks after treatment . The sites of moist desquamation were anterior axillary fold （27/37） and chest wall �

关 键 词：乳腺肿瘤/外科学 乳腺肿瘤/放射疗法 剂量学 急性不良反应 

分 类 号：R737.9[医药卫生—肿瘤]