乳腺癌保乳术后螺旋断层调强放射治疗与静态调强适形放射治疗技术剂量学评估  

Dosimetric evaluation of helical tomotherapy and static intensity-modulated radiotherapy for breast cancer after conservative surgery

作　　者：张富利[1] 蒋华勇[1] 许卫东[1] 王雅棣[1] 高军茂[1] 刘清智[1] 姚波[1] 路娜[1] 陈点点[1] 陈建平[1] 

机构地区：[1]北京军区总医院放疗科,北京100700

出　　处：《生物医学工程与临床》2015年第5期491-493,共3页Biomedical Engineering and Clinical Medicine

基　　金：全军医学计量专项课题资助(2011-JL2-005)

摘　　要：目的 比较乳腺癌保乳术后螺旋断层放射治疗（HT）、静态调强适形放射治疗（IMRT）靶区剂量分布及危及器官受照体积等方面的差异。方法 随机选择20例乳腺癌患者，女性，年龄38 ～ 68岁，中位年龄51.5岁。为每例患者设计上述2种照射技术的治疗计划。处方剂量为50 Gy/2 Gy（25次）。所有计划都使95 %靶区体积达到处方剂量要求。根据积分剂量体积直方图（DVH）比较靶区受照剂量和相关正常器官受照剂量的差异和剂量分布。结果 两种技术靶区均匀性指数（HI）和适形度指数（CI）差异均有显著统计学意义（P = 0.000，P = 0.000）。与静态IMRT相比，HT降低患侧肺在高剂量区的受照体积（V20、V30），但增大了患侧肺（V5、V10）、对侧乳腺（V3）和心脏（V5）的低剂量受照体积。此外，HT延长了患者的治疗时间大约为73.2 %。结论 与静态IMRT相比，HT明显改善了靶区的均匀性和适形度。与此同时，HT增加了各个剂量区危及器官低剂量区域的受照体积，在临床工作应予以关注。Objective To compare the dosage and volume histogram（DVH） of the planning target volume（PTV） and organs at risk（OAR） between helical tomotherapy（HT）, static intensity- modulated radiation therapy（S-IMRT） after breast-conserving surgery.Methods A total of 20 female patients with breast cancer were enrolled, which aged 38- 68 years old with median age of 51.5years old, 2 treatment plans were designed for every patient. The prescribed dosage was 50 Gy/2 Gy/25 f, 95 % of the planning target volume received this dosage. The cumulated DVH and 3D dosage distributions of HT and S-IMRT plans were compared.Results Both HI and CI of PTV showed statistically significant difference between HT and S-IMRT（P = 0.000, P = 0.000）.Compared with S-IMRT, HT showed smaller exposure dosage to ipsilateral lung（V20, V30） in high dosage area and larger exposure dosage to ipsilateral lung（V5, V10）, contralateral breast（V3） and heart（V5） in low dose area. In addition, HT demonstrated an obvious increase of treatment time about 73.2 %. Conclusion Compared with S-IMRT, HT greatly improved the homogeneity and conformity of the PTV. Meanwhile, HT increased the irradiated volume in each dosage area and low-dosage OAR, so it should be concerned in clinic.

关 键 词：乳腺癌 螺旋断层调强放射治疗 静态调强适形放射治疗 辐射剂量 

分 类 号：R737.9[医药卫生—肿瘤] R730.55[医药卫生—临床医学]