深吸气屏气技术在左侧乳腺癌术后放疗中的应用(附41例)  

Implementing deep inspiration breath hold(DIBH)in clinical practice:A dosimetric comparison for left-sided breast cancer(41 cases)

作　　者：胡皓 李敏儿 肖光莉[1] Hu Hao;Li Miner;Xiao Guangli(Department of Oncology,Kiang Wu Hospital,Macao 999078,China)

机构地区：[1]澳门镜湖医院肿瘤科,澳门999078

出　　处：《现代肿瘤医学》2020年第13期2318-2322,共5页Journal of Modern Oncology

摘　　要：目的:探讨深吸气屏气(deep inspiration breath hold,DIBH)技术在左侧乳腺癌术后放射治疗中的剂量学优势。方法:对澳门镜湖医院在2016年4月至2017年12月期间连续收治的41例左侧乳腺癌患者,接受术后放疗的资料进行总结,比较DIBH和自由呼吸(free breath,FB)两种呼吸模式下放疗的剂量学差异,包括靶区适形性(conformity index,CI)和均匀性(homogeneity index,HI)参数,肺、心脏、左侧冠状动脉前降支(LAD)以及右侧乳腺剂量比较。结果:DIBH和FB两种模式下心脏的平均剂量、左侧冠状动脉前降支平均剂量、左肺V 20有显著性差别,分别是(4.92±1.93)Gy vs(6.53±2.30)Gy(P<0.001)、(18.71±9.00)Gy vs(27.21±8.81)Gy(P<0.001)、(23.42±6.67)%vs(28.03±8.68)%(P<0.001)。单纯全乳/胸壁放疗与全乳/胸壁+区域淋巴结放疗两组在DIBH模式下,左肺V 20下降的百分比分别为16.53%和24.86%,差异有统计学意义(P<0.05)。DIBH和FB的靶区适形性和均匀性均无差异。结论:采用DIBH可以显著减少心脏、冠状动脉和肺等重要器官的照射。无论是单纯乳腺/胸壁放疗还是合并区域淋巴结放疗,采用DIBH技术均可以临床获益。Objective:To explore the dosimetric advantages of deep inspiration breath hold(DIBH)technique for the patients with left-sided breast cancer.Methods:A total of 41 patients with left-sided breast cancer admitted to Kiang Wu Hospital for postoperative radiotherapy from April 2016 to December 2017 were retrospectively studied.Each patient underwent breath hold CT(BHCT)and free breathing CT(FBCT).The dosimectric results between DIBH technique and conventional free breath(FB)method were then analyzed.Results:DIBH technique significantly reduced the mean doses of heart,left anterior descending coronary artery(LAD)and left lung V 20 for both cohorts.The doses of the above organ-at-risk(OARs)between DIBH and FB were(4.92±1.93)Gy vs(6.53±2.30)Gy(P<0.001),(18.71±9.00)Gy vs(27.21±8.81)Gy(P<0.001),(23.42±6.67)%vs(28.03±8.68)%(P<0.001).The dose sparing effect in left lung V 20 was more prominent in B/CWRT+RNI than B/CWRT(24.86%vs 16.53%,P=0.026).No significant differences of homogeneity index(HI)and conformity index(CI)values(P-values were 0.201 and 0.223 respectively)were observed indicating that comparable coverage and homogeneity were achieved.Conclusion:This study demonstrates that the implementation of DIBH in clinical setting is feasible and significantly reduced the doses received by the heart,LAD and left lung without compromising the uniformity and conformation of target volumes.The findings suggested that DIBH treatment can benefit all the patients with left-sided breast cancer receiving adjuvant radiotherapy,regardless of with or without regional nodal irradiation.

关 键 词：乳腺癌 深吸气屏气 放射治疗 危及器官 

分 类 号：R730.55[医药卫生—肿瘤]