乳腺癌根治术后IMRT和VMAT放疗技术剂量学研究  

Study of dosimetry on IMRT and VMAT radiotherapy after radical mastectomy for breast cancer

作　　者：陈舒婷[1] 杨帅 姜仁伟[1] 郭栓栓 CHEN Shu-ting;YANG Shuai;JIANG Ren-wei;GUO Shuan-shuan(Cancer Radiotherapy Center,the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院肿瘤放射治疗中心,广东珠海519000

出　　处：《临床医学研究与实践》2019年第9期13-15,共3页Clinical Research and Practice

摘　　要：目的分析乳腺癌根治术后患者采用逆向调强放疗技术(IMRT)和旋转容积调强技术(VMAT)放疗的剂量学分布特征。方法选取我院胸部放疗科2018年1月至2018年6月接受乳腺癌根治术后辅助放疗的40例患者为研究对象,在同一套CT图像上设计9野IMRT和共面二弧VMAT计划,处方剂量均为48 Gy/24次,危及器官限量参考临床要求,并基于MATLAB平台编程获取计划统计结果,在95%的靶区体积达到处方剂量的条件下,比较两种计划的诊断效果。结果 IMRT计划靶区剂量的D_(max)高于VMAT计划,而D_(mean)低于VMAT计划(P<0.05);VMAT计划的HI、CI均优于IMRT计划(P<0.05)。患侧肺IMRT计划危及器官剂量的V_(20)、V_(30)、D_(max)、D_(mean)均高于VMAT计划,健侧肺IMRT计划危及器官剂量的V_5、D_(max)均高于VMAT计划,健侧乳腺IMRT计划危及器官剂量的D1cc、Dmax、Dmean均低于VMAT计划,心脏IMRT计划危及器官剂量的V_5、V_(20)、V_(30)、D_(mean)均低于VMAT计划,脊髓IMRT计划危及器官剂量的D_(1cc)和D_(mean)均低于VMAT计划,肝IMRT计划危及器官剂量的V_(50)及D_(max)均低于VMAT计划(P<0.05)。IMRT计划的V_(100)、V_(90)、V_(70)照射剂量、D_(max)均高于VMAT计划,V_(50)、V_(30)照射剂量均低于VMAT计划(P<0.05)。VMAT计划平均机器跳数为(765.00±12.00)MU,低于IMRT计划的(1 154.00±15.00)MU(P<0.05);VMAT计划的平均治疗时间为(3.50±0.40)min,低于IMRT计划的(7.20±0.60)min(P<0.05)。结论乳腺癌根治术后患者采用IMRT和VMAT两种治疗计划,靶区均能获得较满意的剂量分布,对危及器官的保护方面,两种计划都有各自的优势,但VMAT计划的靶区适形度和均匀度更佳。Objective To discuss the dose distribution characteristic of reverse intensity modulated radiotherapy(IMRT)and volumetric-modulated arc therapy(VMAT)after radical mastectomy for breast cancer patients.Methods Forty patients who received adjuvant radiotherapy after radical mastectomy from January 2018 to June 2018 in the department of chest radiotherapy in our hospital were selected as the research objects.Nine fields IMRT and two-arc coplanar VMAT were designed on the same set of CT images.The prescription doses were 48 Gy/24 times,and the clinical requirements of organ-threatening limitation were referred.Statistical results of the plan were obtained by programming based on MATLAB platform.Under the condition of 95%of target area volume reached the prescription,the diagnostic effects of the two plans were compared.Results The target dose Dmax of IMRT plan was higher than that of VMAT plan,while Dmean was lower than that of VMAT plan(P<0.05).The HI and CI of VMAT plan were better than those of IMRT plan(P<0.05).The organ-threatening doses of V20,V30,Dmax and Dmean of ill side lung IMRT plan were higher than those of VMAT plan,the organ-threatening doses of V5 and Dmax in the contralateral lung IMRT plan were higher than those in the VMAT plan,the organ-threatening doses of D1cc,Dmax and Dmean in the contralateral breast IMRT plan were lower than those in VMAT plan,the organ-threatening doses of V5,V20,V30 and Dmean in cardiac IMRT plan were lower than those in VMAT plan,the organ-threatening doses of D1cc and Dmean in spinal IMRT plan were lower than those in VMAT plan,the organ-threatening doses of V50 and Dmax of liver IMRT plan were lower than those of VMAT plan(P<0.05).The doses of V100,V90 and V70 and Dmax in IMRT plan were higher than those in VMAT plan,and the doses of V50,V30 were lower than those in VMAT plan(P<0.05).The average number of machine hops in VMAT plan was(765.00±12.00)MU,which was lower than(1 154.00±15.00)MU in IMRT plan(P<0.05),and the average treatment time in VMAT plan was(3.50±0.40)m

关 键 词：乳腺癌 放射治疗 逆向调强放疗技术 旋转容积调强技术 

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