左乳腺癌保乳术后放疗不同外照射技术所致皮肤受照剂量的比较  

Dosimetric comparison of skin dose for different techniques in left- side breast cancer radiotherapy after breast- conserving surgery

作　　者：张旭[1] 李凯[1] 李娜[1] 贾明轩[1] 

机构地区：[1]中国医科大学附属盛京医院放射治疗中心,辽宁沈阳110022

出　　处：《现代肿瘤医学》2016年第20期3213-3216,共4页Journal of Modern Oncology

摘　　要：目的：比较3D-CRT、IMRT、VMAT三种技术在左乳腺癌保乳术后放疗中皮肤受照剂量的差异。方法：选取10例左乳腺癌保乳术后患者,为每位患者设计3D-CRT、IMRT、VMAT三种计划,比较三种计划间靶区适形度、均匀指数等剂量学参数及皮肤等危及器官受照剂量。结果：靶区适形度IMRT（0.64±0.04）及VMAT（0.64±0.09）均优于3D-CRT（0.33±0.03）（F=82.2,P〈0.05）;均匀指数IMRT及VMAT分别为（0.12±0.02）和（0.11±0.02）,好于3D-CRT（0.14±0.01）（F=8.1,P〈0.05）。皮肤受照剂量比较中V_（30）、V_（40）、V_（45）、V_（50）、Dmean各项指标IMRT及VMAT均好于3C-CRT（F=9.0~125.6,P〈0.05）;对IMRT及VMAT作进一步LSD比较：V_（30）、V_（50）、Dmean差异无统计学意义（P分别等于0.109、0.571、0.258）,而V_（40）及V_（45）VMAT比IMRT分别降低了5.6%和3.47%（P分别等于0.000及0.027）。结论：左乳腺保乳术后放疗中相比于3DCRT,IMRT及VMAT两种技术提供了更好的靶区剂量同时,能够有效降低患者的皮肤受照剂量;而VMAT相比于IMRT可进一步降低皮肤V_（40）及V_（45）受量。Objective： To compare the difference of skin dose for three dimensional conformal radiotherapy（ 3D - CRT）,intensity - modulated radiotherapy（IMRT） and volumetric modulated arc therapy（ VMAT） in left - side breast cancer radiotherapy after breast - conserving surgery. Methods ： Ten patients with left - side breast cancer underwent adjuvant radiotherapy after breast - conserving surgery were enrolled. 3 types of treatment plans（ 3D - CRT, IMRT, VMAT） were designed for each patient. The dosimetry differences of the target and organs at risk （ OARs） among the three techniques were compared. Results： The conformality of the target for the IMRT and VMAT plans were 0. 64 土 0.04 and 0. 64 ±0. 09,respectively,both better than 3D-CRTs 0. 33 ± 0. 03 （ F = 82. 2, P 〈 0. 05）.The homogeneity index for IMRT, VMAT’and 3D - CRT were 0. 12 ±0. 02, 0. 11 ± 0. 02 、 and 0. 14 ± 0. 0 1, respectively（ F = 8. 1〈 0. 05） . For the skin dose,IMRT and VMAT were both better than 3D - CRT in terms of V30, V40, V45, V50, Dmean （F = 9.0 ？125.6, P〈0. 05） . Further LSD comparison showed that between IMRT and VMAT,there was no statistic differ-ence for V30, V50 and Dmean （P = 0. 109,0. 571,0. 258 respectively） ,for the V40 and V45, VMAT was 5 .6% and 3 .47% lower than IMRT respectively（ P = 0. 000 and 0. 027 respectively） . Conclusion： Comparing to 3D - CRT, IMRT and VMAT can achieve better target dose distribution as well as lower skin dose. VMAT can further lower skin V40 and V45compare to IMRT.

关 键 词：乳腺癌 剂量学 皮肤剂量 

分 类 号：R737.9[医药卫生—肿瘤]