野中野调强放疗在左乳腺癌改良根治术后胸壁放疗的剂量学研究  

Field in field intensity-modulated radiotherapy to the chest wall following modified radical mastectomy for left-sided breast cancer:a dosimetric study

作　　者：叶祯开[1] 唐洁 卢耀振[1] 陈艳[1] 谭琛 韦周吉 YE Zhenkai;TANG Jie;LU Yaozhen;CHEN Yan;TAN Chen;WEI Zhouji(Department of Radiotherapy,Minzu Hospital of Guangxi Zhuang Autonomous Region,Nanning 530001,China)

机构地区：[1]广西壮族自治区民族医院放疗科,广西南宁530001

出　　处：《中国医学物理学杂志》2020年第5期541-544,共4页Chinese Journal of Medical Physics

摘　　要：目的:研究采用野中野调强放疗(FIF-IMRT)进行左乳腺癌改良根治术后胸壁放疗的剂量学特点。方法:回顾性分析2014年9月至2019年8月以来行左乳腺癌改良根治术后予胸壁及锁骨区放疗的77例患者资料。患者均接受胸壁及锁骨区行整体化IMRT,胸壁行FIF-IMRT及锁骨区行IMRT这两种治疗方案,采集并比较靶区相关剂量参数、适形度指数、均匀性指数,肺、心脏及右侧乳腺的剂量体积参数的差异。结果:两种治疗方案均达到放疗计划剂量学要求。两种治疗方案的靶区均匀性指数和适形度指数、PTV-Dmax、PTV-Dmean、PTV-V105%,左肺V5、V10、V20、V30、Dmean,右肺V30,全肺V30以及心脏Dmean相比较,均无统计学意义(P>0.05),而PTV-Dmin、PTV-V95%、PTV-V110%、右肺Dmean、V5、V10、V20,全肺Dmean、V5、V20,心脏V5、V30、V40,右侧乳腺Dmean相比较,均有统计学意义(P<0.05)。结论:乳腺癌根治术后胸壁采取FIF-IMRT结合锁骨区IMRT的治疗方案在降低正常组织的剂量照射和受照体积方面优势明显。Objective To study the dosimetric characteristics of field in field intensity-modulated radiotherapy(FIF-IMRT)to the chest wall after modified radical mastectomy for left-sided breast cancer.Methods The clinical information of 77 patients treated with radiotherapy to the chest wall and the supraclavicular area after modified radical mastectomy for left-sided breast cancer between September 2014 and August 2019 were analyzed retrospectively.All of them received two kinds of treatment strategies,namely integrated IMRT to the chest wall and supraclavicular area and fractionated radiotherapy in which FIF-IMRT were designed for the chest wall and IMRT for the supraclavicular area.The related dosimetric parameters,conformity index and homogeneity index of target areas,and the dosimetric parameters of lungs,right-sided breast and the heart were compared between two groups.Results Both two kinds of the treatment strategies met the dosimetric requirements.The comparison between two different groups showed that there were significant differences in PTV-Dmin,PTV-V95%,PTV-V(110%),the Dmean,V5,V10,V20 of the right lung,the Dmean,V5,V20 of lungs,the V5,V30,V40 of heart and the Dmeanof right-sided breast(all P<0.05),but not in the homogeneity index and conformity index of target areas,PTV-Dmax,PTV-Dmeanand PTV-V105%,the V5,V10,V20,V30 and Dmeanof the left lung,the V30 of the right lung,the V30 of lungs,and the Dmeanof the heart(all P>0.05).Conclusion After modified radical mastectomy,fractionated radiotherapy with FIF-IMRT for the chest wall and IMRT for the supraclavicular area has obvious advantages in decreasing doses to normal tissues and reducing the volume to be irradiated.

关 键 词：乳腺癌 胸壁 野中野调强放疗 剂量学 

分 类 号：R737.9[医药卫生—肿瘤]