3种不同放疗技术在左侧乳腺癌保乳术后全乳腺放疗中的剂量学比较  

Dosimetric comparison of three different radiotherapy techniques in whole breast radiotherapy after breast-conserving surgery for left breast cancer

作　　者：柴林燕[1] 王科峰[2] 张晓智[1] 范秋红 Chai Linyan;Wang Kefeng;Zhang Xiaozhi;Fan Qiuhong(Department of Radiotherapy,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Endocrinology,the Second Affiliated Hospital of Xi'an Medical University,Xi'an 710038,China;Department of Radiotherapy,the Ninth Hospital of Xi'an,Xi'an 710069,China)

机构地区：[1]西安交通大学第一附属医院放疗科,710061 [2]西安医学院第二附属医院内分泌科,710038 [3]西安市第九医院放疗科,710069

出　　处：《国际放射医学核医学杂志》2020年第9期569-574,共6页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：陕西省科技厅重点研发计划(2019SF-145)。

摘　　要：目的比较3种调强放疗技术在早期左侧乳腺癌保乳术后全乳腺放疗中的剂量学差异。方法回顾性分析2019年3月至8月在西安交通大学第一附属医院治疗的12例早期左侧乳腺癌保乳术后女性患者,年龄32~50(42.4±6.8)岁。分别设计基于固定角度适形调强放疗的混合调强(3DCRT+IMRT)、容积旋转调强放疗的混合调强(3DCRT+VMAT)和切线弧容积旋转调强放疗计划(t-VMAT),并比较3种放疗计划的计划靶区、危及器官剂量参数以及治疗效率的差异。组间数据比较采用配对t检验。结果3种调强放疗计划的靶区剂量分布和危及器官受量均能满足临床要求。3DCRT+IMRT和t-VMAT两种计划相比,3DCRT+VMAT的靶区剂量学指标适形性指数(0.84±0.05对0.74±0.06对0.79±0.06)和均匀性指数(0.10±0.03对0.14±0.03对0.13±0.03)最优,差异均有统计学意义(t=−9.01~6.47,均P<0.05);3DCRT+IMRT对患侧(左)肺的V5[(35.92±8.01)%对(49.33±12.05)%对(60.58±12.94)%]、V10[(25.50±6.91)%对(26.92±7.23)%对(41.25±10.37)%]、Dmean[(10.14±2.43)Gy对(11.07±2.88)Gy对(14.52±3.32)Gy]和健侧(右)肺的V5[(0.50±1.45)%对(2.17±3.76)%对(3.00±4.94)%]、Dmean[(0.55±0.21)Gy对(1.79±0.58)Gy对1.75±0.70)Gy]及健侧(右)乳腺的V5[(0.17±0.58)%对(1.92±4.10)%对(8.25±8.61)%]、Dmean[(0.86±0.38)%对(1.65±0.45)%对(2.46±0.86)%]的保护最好。3DCRT+VMAT的心脏V30[(4.50±2.88)%对(5.00±3.25)%对(8.42±2.78)%]、V40[(2.50±2.11)%对(3.25±2.53)%对(4.58±2.07)%]明显优于3DCRT+IMRT和t-VMAT,且差异均有统计学意义(t=−17.11~3.45,均P<0.05)。3DCRT+IMRT的平均机器跳数最小(280.90±52.18),t-VMAT的治疗时间最短。结论3DCRT+IMRT在低剂量区(<20 Gy)对健侧肺、患侧肺,健侧乳腺等危及器官的保护比较好,3DCRT+VMAT在提高靶区的均匀性和适形性方面有明显优势,且在高剂量区(>20 Gy)对患侧肺及心脏保护更好,t-VMAT缩短了治疗时间,提高了治疗效率和患者舒适度。Objective To compare the dosimetry of three different intensity-modulated radiation therapy(IMRT)techniques in patients undergoing whole-breast radiotherapy after breastconserving surgery for early left breast cancer.Methods Between March 2019 and August 2019,12 female patients with early left breast cancer who underwent breast-conservative surgery in the First Affiliated Hospital of Xi'an Jiaotong University were analyzed retrospectively.The patient age was between 32 and 50 years,with an average of 42.4±6.8 years.The IMRT-based hybrid plan(3D conformal radiation therapy or 3DCRT+IMRT),the volumetric modulated arc therapy(VMAT)-based hybrid plan(3DCRT+VMAT),and the tangential VMAT plan(t-VMAT)were designed.The dosimetric parameters of the target and the organs at risk and treatment efficiency were compared among the three plans,and t-test was used for data analysis.Results Both the dose distribution in the target and dose to the organs at risk can meet the clinical requirements of the three plans.The conformal index(0.84±0.05 vs.0.74±0.06 vs.0.79±0.06)and uniformity index(0.10±0.03 vs.0.14±0.03 vs.0.13±0.03)of 3DCRT+VMAT were the best,and the difference was statistically significant compared with the two other plans(t=–9.01–6.47,all P<0.05).The protective effect of 3DCRT+IMRT was the best for V5((35.92±8.01)%vs.(49.33±12.05)%vs.(60.58±12.94)%),V10((25.50±6.91)%vs.(26.92±7.23)%vs.(41.25±10.37)%),Dmean((10.14±2.43)Gy vs.(11.07±2.88)Gy vs.(14.52±3.32)Gy)of the ipsilateral(left)lung,V5((0.50±1.45)%vs.(2.17±3.76)%vs.(3.00±4.94)%),and Dmean((0.55±0.21)Gy vs.(1.79±0.58)Gy vs.(1.75±0.70)Gy)of the contralateral(right)lung and the V5((0.17±0.58)%vs.(1.92±4.10)%vs.(8.25±8.61)%)and Dmean((0.86±0.38)Gy vs.(1.65±0.45)Gy vs.(2.46±0.86)Gy)of the contralateral(right)breast.3DCRT+VMAT was significantly better than 3DCRT+IMRT and t-VAMT in V30((4.50±2.88)%vs.(5.00±3.25)%vs.(8.42±2.78)%)and V40((2.50±2.11)%vs.(3.25±2.53)%vs.(4.58±2.07)%)of the heart(t=–17.11–3.45,all P<0.05).The mean monito

关 键 词：乳腺肿瘤 放射治疗计划 计算机辅助 放射疗法 调强适形 容积旋转调强放疗 剂量学 

分 类 号：R737.9[医药卫生—肿瘤]