基于VMAT的固定钨门技术在左侧乳腺癌改良根治术后放疗中的应用  

Application of fixed-jaw technology base on VMAT in radiotherapy for left breast cancer after modified radical mastectomy

作　　者：柴林燕[1] 周灿 王科峰[3] 张晓智[1] Chai Linyan;Zhou Can;Wang Kefeng;Zhang Xiaozhi(Department of Radiotherapy,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710061,China;Department of Breast Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710061,China;Department of Endocrinology,the Second Affiliated Hospital of Xi'an Medical University,Shaanxi Xi'an 710038,China)

机构地区：[1]西安交通大学第一附属医院放疗科,陕西西安710061 [2]西安交通大学第一附属医院乳腺外科,陕西西安710061 [3]西安医学院第二附属医院内分泌科,陕西西安710038

出　　处：《现代肿瘤医学》2020年第19期3409-3413,共5页Journal of Modern Oncology

基　　金：陕西省科技厅重点研发计划(编号:2019SF-145)。

摘　　要：目的:比较固定钨门和常规非固定钨门技术在左侧乳腺癌改良根治术后VMAT计划中的剂量学特点,并探讨其临床应用价值。方法:选取12例左侧乳腺癌改良根治术后女性患者,分别设计固定钨门F-VMAT计划和常规非固定钨门N-VMAT计划,并比较两组计划的靶区、危及器官剂量参数以及治疗效率的差异。结果:两组调强计划的靶区剂量分布相似,适形性指数CI和均匀性指数HI值组间比较无统计学差异(P>0.05);在危及器官保护方面,F-VMAT计划的患侧肺,健侧肺的低剂量(<2 000 cGy)照射体积以及人体全身受照的V5明显低于N-VMAT组(P<0.05),且进一步保护了左侧肱骨头,脊髓PRV,对侧乳腺,组间比较均有统计学意义(P<0.05);在治疗效率方面,F-VMAT组的平均机器跳数比N-VMAT组增加了34.5%,多弧照射还增加了机架旋转次数,延长了治疗时间。结论:虽然F-VMAT计划延长了治疗时间,但其靶区剂量分布与N-VMAT相当,尤其是在危及器官的保护方面F-VMAT计划具有绝对优势,故F-VMAT计划在左侧乳腺癌改良根治术后放疗中具有较好的临床应用价值。Objective:To compare the dosimetric characteristics between the fixed jaw technology and the normal non-fixed jaw technology in VMAT plan for left breast cancer after modified radical mastectomy,and to explore the clinical application value.Methods:The fixed jaw technology F-VMAT plan and the normal non-fixed jaw technology N-VAMT plan were designed for 12 female patients with left breast cancer after modified radical mastectomy respectively,then the differences of target area,the radiation doses of organs at risk and treatment efficiency between the two groups were compared.Results:The dose distribution of target area in the two groups was similar,and there was no significant difference in conformity index(CI) and homogeneity index(HI) between the two groups(P>0.05).In terms of organ at risk protection,the low dose(<2 000 cGy) volume of ipsilateral lung,contralateral lung and the whole body V5 in the F-VMAT group were significantly lower than the N-VAMT group(P<0.05).The F-VMAT plan better protected the left humerus,spinal cord PRV and contralateral breast,and there was significant statistical difference between the two groups(P<0.05).In terms of treatment efficiency,the monitor units of the F-VMAT was 34.5%,higher than the N-VAMT,and the multi arc increased the number of frame rotations,prolonged the treatment time.Conclusion:The F-VMAT prolongs the treatment time,but the dose distribution in target area is similar to the N-VAMT group.The F-VMAT plan has absolute advantage in the protection of organs at risk especially,which has potential value in clinical application.

关 键 词：乳腺癌 固定钨门 容积旋转调强放疗 

分 类 号：R737.9[医药卫生—肿瘤]