TomoDirect技术在乳腺癌术后胸壁放疗中的应用  

TomoDirect in chest wall irradiation for postoperative patients receiving radical mastectomy

作　　者：何亚男[1] 罗焕丽 靳富[1] 柳先锋[1] 吴丽华[1] 

机构地区：[1]重庆市肿瘤研究所/医院/癌症中心,重庆400030

出　　处：《中国医学物理学杂志》2017年第6期555-560,578,共7页Chinese Journal of Medical Physics

基　　金：国家自然科学基金(11575038);重庆市卫生计生委医学科研项目(2015MSXM229)

摘　　要：目的:探究螺旋断层固定野调强放疗(TD)技术在乳腺癌改良根治术后胸壁放疗中的应用,为临床提供指导。方法:收集本院10例乳腺癌根治术后患者(左乳5例、右乳5例),利用Eclipse10.0、Tomo Therapy计划系统,分别制作适形固定野调强放疗(IMRT)、容积弧形调强(Rapid Arc)、螺旋断层调强放疗(HT)、TD计划。比较4种计划在靶区适形度(CI)、剂量均匀性(HI)和危及器官的剂量分布、机器跳数(MU)的差异。结果:Rapid Arc的CI达到0.86±0.01(左)、0.81±0.03(右),HT的HI低至0.04±0.00(左)、0.04±0.00(右),与其它技术相比,均有统计学差异(P<0.05)。患侧肺、总肺的V_(20)、V_(30) 在Rapid Arc中值最低,为11.64±0.45、4.53±0.35(左),19.25±6.11、9.19±3.60(右);左侧病例中患侧肺V_5在TD中最低,为41.61±3.97,右侧病例中患侧肺V_5在HT中最低,为40.08±2.47。对健侧肺而言,TD占明显优势,不仅V_(20)、V_(30) 为0,其V_5值也低至0.56±0.18(左)、3.84±1.93(右)。左侧病例的心脏V_(30) 在Rapid Arc中最低,为1.75±0.21;心脏V_(10)则在TD中占优势,为25.27±0.96,与其它技术相比(P<0.05)。脊髓的最小值在IMRT中最低,平均值和最大值在TD中最低(P<0.05)。身体低剂量区在IMRT、TD计划中最低(P<0.05)。MU则在IMRT、Rapid Arc中最小。结论:作为一种乳腺癌术后胸壁放疗的新技术,TD在危及器官保护上有一定优势,临床中可与其他3种技术配合使用。Objective To explore the advantage of Tomo Direct in the chest wall irradiation for patients after undergoing radical mastectomy,providing guidance for clinical use.Methods Ten patients after radical mastectomy for breast cancer（including 5patients with left breast cancer and 5 with right breast cancer） were selected in the study.For the chest wall irradiation in 10 patients,intensity-modulated radiotherapy（IMRT） and volumetric-modulated arc therapy（Rapid Arc） plans were generated on Varian Eclipse treatment planning system（TPS）,and helical tomotherapy（HT） and Tomo Direct（TD） plans were also generated on tomotherapy TPS.The conformity index（CI）,homogeneity index（HI） of target areas,dosimetric distribution of organ at risks（OAR）,monitor unit（MU） were compared among four plans.Results The CI in Rapid Arc plan for left and right breast cancers was 0.86±0.01,0.81±0.03,respectively,and HI in HT plan was 0.04±0.00,0.04±0.00,respectively,with significant difference compared with those in the other plans（P〈0.05）.The V20,V30 of ipsilateral lung and total lung was lowest in Rapid Arc plan（11.64±0.45,4.53±0.35 for left breast cancer,and 19.25±6.11,9.19±3.60 for right breast cancer）.The lowest V5 of ipsilateral lung in patients with left breast cancer was 41.61±3.97 which was found in TD plan,and that in patients with right breast cancer was40.08±2.47 which was found in HT plan.For the contralateral lung,TD plan showed significant advantages because the V20,V30 of contralateral lung in TD plan was zero,and that the V5 of contralateral lung in TD plan was 0.56±0.18,3.84±1.93 for the left and right breast cancer,respectively.The V30 was lowest in Rapid Arc plan（1.75±0.21）（P〈0.05）,and the V_（10 ）of heart was lowest in TD plan（25.27±0.96）,with significant difference compared with those in the other plans（P〈0.05）.The lowest minimum dose of spinal cord was observed in IMRT plan,while the lowest mean and maximum doses of spinal cord were found i

关 键 词：乳腺癌 TomoDirect 固定野调强放疗 容积弧形调强 螺旋断层调强放疗 胸壁放疗 

分 类 号：R737.9[医药卫生—肿瘤] R815.2[医药卫生—临床医学]