早期乳癌保乳术后常规与调强放疗剂量学及近期毒性反应比较  

A COMPARATIVE STUDY OF DOSIMETRY AND SHORT-TERM TOXICITY BETWEEN CONVENTIONAL RADIOTHERAPY AND INTENSITY-MODULATED RADIOTHERAPY AFTER BREAST-CONSERVING SURGERY FOR EARLY BREAST CANCER

作　　者：孙浩 

机构地区：[1]郑州大学附属肿瘤医院放疗科,河南郑州450008

出　　处：《齐鲁医学杂志》2017年第3期270-273,共4页Medical Journal of Qilu

摘　　要：目的探讨早期乳癌保乳术后常规与调强放疗剂量学与近期毒性反应比较。方法选择左侧早期乳癌行保乳术后放射治疗病人80例,随机分为常规放射治疗组(常规组)与调强放射治疗组(调强组)。比较两组病人急性放射性皮炎、放射性肺炎、美容效果以及放射性心肌损伤差异。随机选择30例调强放疗病人,CT模拟定位勾勒靶区与危及器官,Eclipse三维计划系统设计常规切线野放疗计划。将两种计划融合分析,利用计划靶区剂量分布云图对比分析两种放疗技术病人靶区放射剂量分布、均匀性指数(HI)与适形性指数(CI),同时采用剂量体积直方图对心、肺、健侧乳房3种危及器官受照剂量及照射体积进行比较。结果调强组病人近期放射性肺炎、放射性皮炎、心肌损伤发生率低于常规组(z=3.672~5.098,P<0.05);两组病人美容效果比较差异无显著性(P>0.05)。治疗后,常规组病人血清高敏C反应蛋白、肌钙蛋白水平以及ST-T段异常与心律失常发生率显著高于调强组(t=2.173、2.784,χ2=2.684、2.870,P<0.05)。与常规组比较,调强组计划靶区照射剂量体积百分比V100%、V110%、V115%降低,CI、HI升高(t=2.018~3.278,P<0.05);两组病人V95%比较,差异无显著性(P>0.05)。调强组患侧肺脏计划靶区接受照射剂量百分体积V20、V30、V40,心脏V30、V40水平降低,健侧乳房V2、V3、V4以及患侧肺脏、心脏、健侧乳房V5较常规组明显升高(t=2.405~3.976,P<0.05)。结论调强放射治疗计划靶区剂量分布适形性与均匀性较好,危及器官受照剂量及体积显著减小,可以减轻左侧早期乳癌保乳术后放射治疗近期毒性不良反应。Objective To compare the dosimetry and the short-term toxicity between conventional radiotherapy and intensity-modulated radiotherapy（IMRT）after breast-conserving surgery for early breast cancer. Methods Eighty patients with early left breast cancer who received radiotherapy after breast-conserving surgery were randomly divided into conventional radiotherapy group and IMRT group.The acute radiation dermatitis,radiation pneumonitis,cosmetic effect,and radioactive myocardial injury were compared between the two groups.Thirty patients receiving IMRT were randomly selected to perform CT simulation to delineate the target volume and the organs at risk.The Eclipse 3Dplanning system was used to design the routine tangential field radiotherapy plan.The radiation dose distribution,uniformity index（HI）,and conformity index（CI）of the target volume were analyzed and compared between the two groups using the dose distribution image of the planning target volume.The dose-volume histogram was used to compare the radiation dose and irradiation volume of the organs at risk（heart,lung,and contralateral breast）between the two groups. Results The IMRT group had significantly lower incidence rates of radiation pneumonitis,radiation dermatitis,and myocardial injury than the conventional radiotherapy group（z=3.672-5.098,P〈0.05）.There was no significant difference in cosmetic effect between the two groups（P〉0.05）.After radiotherapy,the conventional radiotherapy group had significantly higher serum levels of C-reactive protein and troponin and incidence rates of ST-T segment abnormalities and arrhythmia than the IMRT group（t=2.173,2.784;χ2=2.684,2.870;P 〈0.05）.Compared with the conventional radiotherapy group,the IMRT group had significantly lower V100%（percent volume receiving 100% of the prescribed dose）,V110%,and V115%,and significantly higher CI and HI（t=2.018-3.278,P〈0.05）.There was no significant difference in V95% between the two groups（P〉0.05）.Compared with the conventional radio

关 键 词：乳癌 放射治疗 剂量学 毒性反应 

分 类 号：R815.2[医药卫生—放射医学]