等效均匀剂量优化在乳腺癌根治术后胸壁放疗中的应用价值  

Application of equivalent uniform dose(EUD)-based optimization for chest wall radiotherapy following radical mastectomy

作　　者：吴哲 庞亚 刘可 明智[1] 王东[1] 陈晓梅[1] 王琳[1] 晏军[1] Zhe;PANG Ya;LIU Ke;MING Zhi;WANG Dong;CHEN Xiaomei;WANG Lin;YAN Jun(Department of Oncology,Zigong First People's Hospital,Zigong 643000,China)

机构地区：[1]自贡市第一人民医院肿瘤科,643000 [2]自贡市第一人民医院护理部,643000

出　　处：《浙江医学》2021年第4期409-413,共5页Zhejiang Medical Journal

摘　　要：目的探讨等效均匀剂量(EUD)优化在乳腺癌根治术后胸壁放疗中的应用价值。方法选取2019年1月至2020年1月自贡市第一人民医院肿瘤科26例乳腺癌根治术后拟行胸壁放疗的患者,对每例患者制定3组固定野调强计划。第1组计划直接采用常规剂量体积物理约束条件(physics-plan);第2组计划在physics-plan基础上对计划靶区(PTV)增加Target-gEUD目标函数;第3组计划在physics-plan基础上对危及器官(OAR)增加Upper gEUD目标函数。比较3种放疗计划的PTV与OAR的剂量学差异。结果Target-gEUD目标函数计划较physics-plan的靶区适形度和均匀性更好(P<0.05),靶区D2降低(P<0.05),但是患侧肺V_(5)、V_(20)、V_(30),健侧肺V_(5)受照体积均升高(均P<0.05),心脏V_(30)、V_(40)、D_(mean),脊髓Dmax和健侧乳腺D_(mean)的差异均无统计学意义(均P>0.05)。Upper-gEUD目标函数计划较physics-plan的患侧肺V_(5)、V_(20)、V_(30),健侧肺V_(5)、V_(20)受照体积都降低,心脏V_(30)、V_(40)、D_(mean),脊髓Dmax均下降(均P<0.05),健侧乳腺D_(mean)的差异无统计学意义(P>0.05),但靶区均匀性和适形度也更差(P<0.05)。结论EUD优化应用到乳腺癌患者根治术后胸壁放疗中能满足靶区照射剂量的同时,也能降低肺和心脏等OAR的受照体积,有一定的临床应用价值。Objective To evaluation the efficacy and safety of the application of generalized equivalent uniform dose(EUD)optimization in chest wall radiotherapy after radical mastectomy.Methods Clinical data of 26 patients with breast cancer undergoing chest wall radiotherapy after radical mastectomy at Zigong First People’s Hospital between January 2019 and January 2020 were retrospectively analyzed.Three groups of fixed-field intensity-modulated radiation therapy(IMRT)were applied for each patients:the first group was direct using the conventional dose-volume physical constraints(physics-plan),The second group was adding the EUD target function(Target-gEUD)to the target PTV based on the physics-plan,The third group adding the EUD target function(Upper gEUD)to the organs at risk(OARs)based on the physics-plan.The dosimetric parameters for PTV and OARs of the three groups of plans were compared.Results Compared with the physics-plan group,the Target-gEUD plan group had better conformity and uniformity of the PTV,and the difference was statistically significant(P<0.05).The PTV D2 decreased,the difference was statistically significant(P<0.05).However,the exposure volume of ipsilateral lung V_(5),V_(20),V_(30),and contralateral lung V_(5)were all increased,and the differences were statistically significant(P<0.05).The V_(30),V_(40),D_(mean)for heart,Dmaxfor spinal cord,and D_(mean)for contralateral breast had no significance(P>0.05).Compared with the physics-plan group,the exposure volume V_(5),V_(20),and V_(30)of the ipsilateral lung,and V_(5),V_(20)of the contralateral lung in the Upper-gEUD plan group were reduced,the V_(30),V_(40),D_(mean)for heart,and Dmax for spinal cord were also decreased,the differences were all statistically significant(P<0.05),and there was no statistically significant difference in the D_(mean)for the contralateral breast(P>0.05).But the uniformity and conformity of PTV were worse(P<0.05).Conclusion Dose volume combined with EUD optimization can be applied to chest wall radiotherapy for breast ca

关 键 词：等效均匀剂量 乳腺癌 调强放疗 剂量学 

分 类 号：R730.55[医药卫生—肿瘤] R737.9[医药卫生—临床医学]