调强放射技术与切线野三维适形技术在乳腺癌保乳术后的应用价值  

Application Value of IMRT and Three-dimensional Conformal Technique ofTangent Field in Breast Cancer Patients after Breast Conserving Surgery

作　　者：童薇[1] 郑杰[1] 沈学明[2] 雍翔 TONG Wei;ZHENG Jie(The General Hospital of North Anhui Coal and Electricity Group Radiotherapy department,Anhui Suzhou 234011,China)

机构地区：[1]皖北煤电集团总医院,安徽宿州234011 [2]蚌埠医学院第一附属医院放疗科,安徽蚌埠233004

出　　处：《河北医学》2020年第5期778-784,共7页Hebei Medicine

基　　金：安徽省卫生厅科研项目,(编号:2017LB0019)。

摘　　要：目的:探讨调强放射技术与切线野三维适形技术在乳腺癌保乳术后的应用价值。方法:选取2017年11月至2019年11月我院乳腺癌保乳术后患者82例,依据治疗方案不同分为调强组与适形组,各41例。适形组采取切线野三维适形技术,调强组采取调强放射技术。统计两组全乳靶区剂量分布情况、全肺受量、心脏受量、治疗前后miR-765及miR-21相对表达量、T细胞亚群指标水平、毒副反应发生情况。结果:调强组CI、Dmean高于适形组,HI、Dmax小于适形组(P<0.05),两组Dmin比较无显著差异(P>0.05);调强组Dmean及V5小于适形组(P<0.05),两组V20比较无显著差异(P>0.05);调强组Dmean及V20、V40小于适形组(P<0.05);治疗后两组miR-765相对表达量较治疗前增高,miR-21较治疗前降低,且调强组miR-765相对表达量高于适形组,miR-21低于适形组(P<0.05);治疗后两组CD3+、CD4+、CD4+/CD8+较治疗前降低,CD8+较治疗前增高,但调强组CD3+、CD4+、CD4+/CD8+高于适形组,CD8+低于适形组(P<0.05);调强组骨髓抑制(29.27%)、急性皮肤反应(63.41%)发生率低于适形组(53.66%、82.93%)(P<0.05)。结论:采取调强放射技术治疗乳腺癌保乳术后患者效果优于切线野三维适形技术,可保证各区域照射剂量合理性,对患者免疫功能影响小,并能调节miR-765及miR-21相对表达,且可在一定程度上降低毒副反应发生风险,保证安全性。Objective:To explore the application value of intensity modulated radiation technology and three-dimensional conformal technique with tangent field in breast cancer patients after breast conserving surgery.Methods:82 patients with breast cancer after breast-conserving surgery in our hospital from November 2017 to November 2019 were selected.They were divided into intensity-modulated group and conformal group,with 41 patients in each group.The conformal group adopts the tangent field three-dimensional conformal technology,and the intensity-modulated group adopts the intensity-modulated radiation technology.The dose distribution of whole milk target area,total lung volume,cardiac volume,relative expression levels of miR-765 and miR-21 before and after treatment,levels of T cell subgroup indicators,and occurrence of toxicities were calculated.Results:CI and Dmean in the intensity-modulated group were higher than those in the conformal group,HI and Dmax were lower than those in the conformal group(P<0.05),and there was no significant difference in Dmin between the two groups(P>0.05);Dmean and V5 in the intensity-modulated group were lower than those in the conformal group(P<0.05),and there was no significant difference in V20 between the two groups(P>0.05);Dmean,V20 and V40 in the intensity-modulated group were lower than those in the conformal group(P<0.05);After treatment,the relative expression of miR-765 in the two groups was higher than that before treatment,and miR-21 was lower than that before treatment,the relative expression of miR-765 in the intensity-modulated group was higher than that in the conformal group,and miR-21 was lower than that in the conformal group(P<0.05);After treatment,the CD3+,CD4+,and CD4+/CD8+in the two groups were lower than before treatment,and the CD8+was higher than before treatment,but the CD3+,CD4+,CD4+/CD8+in the IM group were higher than the conformal group,and the CD8+was lower than the conformal group(P<0.05);The incidence of myelosuppression(29.27%)and acute skin reaction(63.

关 键 词：调强放射技术 切线野三维适形技术 乳腺癌 免疫功能 

分 类 号：R737.9[医药卫生—肿瘤]