乳腺癌保乳术后全乳及锁骨上下区三种调强剂量学分析  

Dosimetric comparison between three radiotherapy regimens involving supraclavicular and infraclavicular regions in breast cancer patients after breast-conserving surgery

作　　者：陈慧茹 王石[2] 吴朝霞[2] 李晓 段影 陈梁 张健 郭兴东 甘霖 燕存青 邹跃 Chen Huiru Wang shi Wu Zhaoxia Li Xiao Duan Yin Chen Liang Zhang Jian Guo Xingdong Gan Lin Yan Cunqing Zou Yue(Department of Radiation Oncology, The General Hospital of the PLA Rocket Force, Beijing i00088, Chin Tsinghua University ,Beijing 100084, Chin)

机构地区：[1]火箭军总医院放疗科,北京100088 [2]清华大学,100084

出　　处：《中华放射肿瘤学杂志》2017年第7期774-777,共4页Chinese Journal of Radiation Oncology

摘　　要：目的 比较乳腺癌保乳术后全乳及锁骨上下区同时照射的固定野静态IMRT、固定野动态IMRT （DMLC）与VMAT的剂量学差异.方法 选择2012-2015年本院女性乳腺癌患者14例,照射范围包括胸壁及锁骨上下区.每例患者分别设计3种计划并使用相同优化条件,以DVH为依据比较PTV及OAR剂量.采用单因素方差分析或非参数Wilcoxon符号秩检验.结果 IMRT、DMLC、VMAT三者的V95、V98、CI、HI值组间比较结果均为VMAT最优（P〈0.009）.患侧肺V5、V20及Dmean值,健侧肺V5及Dmean值VMAT计划值均最优（P〈0.022）.脊髓平均剂量VMAT最低（P=0.004）.结论 对于全乳及锁骨上下区的乳腺癌患者治疗方式首选VMAT,在能保证靶区剂量的同时有效控制正常组织受量,减轻放疗并发症的风险.Objective To evaluate the dosimetric difference between fixed-field static intensity-modulated radiotherapy （IMRT）, fixed-field dynamic multileaf collimator （DMLC）, and volumetric modulated arc therapy （VMAT）, all of which involve supraclavicular and infraclavicular regions, in breast cancer patients after breast-conserving surgery.Methods This study included 14 female patients with breast cancer who received radiotherapy after breast-conserving surgery in our hospital from October 2012 to April 2016.The radiation field included the chest wall and supraclavicular and infraclavicular regions.IMRT, DMLC, and VMAT plans were generated for each patient while using identical optimization conditions.The doses to planning target volume （PTV） and organs at risk （OARs） were compared based on dose-volume histogram （DVH）;one-way analysis of variance or nonparametric Wilcoxon rank test was used for comparison.Results For the dose distribution of PTV, VMAT achieved the best V95, V98, CI, and HI （P〈0.009）.Concerning the doses to OARs, VMAT achieved the best V5, V20, and Dmean of the ipsilateral lung and the best V5 and Dmean of the contralateral lung （P〈0.022）.Dmean of the spinal cord was significantly lower in VMAT than in IMRT and DMLC （P=0.004）.Conclusions VMAT is preferred for the patients with breast cancer to be treated with radiotherapy involving supraclavicular and infraclavicular regions after breast-conserving surgery.It can improve the dose distribution of target and reduce the doses to organs at risk and radiotherapy toxicities.

关 键 词：乳腺肿瘤/调强放射疗法 乳腺肿瘤/容积调强弧形疗法 剂量学 

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