左乳腺癌保乳术后全乳腺野中野正向调强放疗与固定野逆向调强放疗剂量分布比较  

Dosimetric distribution comparison of field-in-field intensity-modulated radiotherapy and fixed field inversely optimized intensity-modulated radiotherapy for left breast cancer after breast-conserving surgery

作　　者：钟玉芳 钱普东 翟振宇[3] 韩晶晶[2] 孙秀锦 朱焕峰 Zhong Yufang;Qian Pudong;Zhai Zhenyu;Han Jingjing;Sun Xiujin;Zhu Huanfeng(Department of Oncology,Tianchang People's Hospital of Anhui Province,Tianchang 239300,China;Department of Radiation Therapy,Cancer Hospital of Nanjing Medical University/Institute of Prevention and Treatment,Jiangsu Cancer Hospital,Nanjing 210009,Chi;Department of Physics,Cancer Hospital of Nanjing Medical University/Institute of Prevention and Treatment,Jiangsu Cancer Hospital,Nanjing 210009,China)

机构地区：[1]安徽省天长市人民医院肿瘤科,239300 [2]南京医科大学附属肿瘤医院,江苏省肿瘤医院,江苏省肿瘤防治研究所放射治疗科,南京210009 [3]南京医科大学附属肿瘤医院江苏省肿瘤医院,江苏省肿瘤防治研究所物理室,南京210009

出　　处：《肿瘤研究与临床》2020年第12期835-839,共5页Cancer Research and Clinic

摘　　要：目的探讨左乳腺癌保乳术后全乳腺野中野正向调强放疗(FIF-IMRT)与固定野逆向调强放疗(FFIO-IMRT)剂量分布的差异。方法选取江苏省肿瘤医院2016年10月至2018年12月早期左乳腺癌保乳术后患者10例,均设计FIF-IMRT与FFIO-IMRT两组放疗计划,乳腺处方剂量为50 Gy,25次,5次/周,2 Gy/次。在计划靶区满足处方剂量前提下,用剂量-体积直方图(DVH)比较两种计划中计划靶体积(PTV)、危及器官、治疗跳数的剂量学差异。结果PTV方面,两种计划适形指数(CI)差异无统计学意义(P>0.05);FIF-IMRT均匀性指数(HI)高于FFIO-IMRT(0.13±0.02比0.10±0.04,P<0.05);两种计划95%处方剂量曲线包括的体积比例(V_(95%))、V_(100%)及最大放疗剂量(D_(max))差异均无统计学意义(均P>0.05);FIF-IMRT V105%及平均放疗剂量(D_(mean))均高于FFIO-IMRT[(37.63±8.85)%比(18.64±5.27)%,(51.81±0.17)Gy比(51.37±0.26)Gy,均P<0.05]。心脏剂量方面,两种计划不小于30 Gy照射的体积比例(V30_(Gy))、V_(40Gy)、D_(max)差异均无统计学意义(均P>0.05);FIF-IMRT V5_(Gy)、V10_(Gy)、D_(mean)均低于FFIO-IMRT(均P<0.05)。冠状动脉剂量方面,两种计划V20_(Gy)、V30_(Gy)、D_(max)、D_(mean)差异均无统计学意义(均P>0.05),FIF-IMRT V5_(Gy)、V10_(Gy)均低于FFIO-IMRT(均P<0.05)。左心室剂量方面,两种计划V20_(Gy)、V30_(Gy)、V_(40Gy)、D_(max)差异均无统计学意义(均P>0.05);FIF-IMRT V5_(Gy)、V10_(Gy)、D_(mean)均低于FFIO-IMRT(均P<0.05)。左肺剂量方面,两种计划V20_(Gy)、V30_(Gy)、D_(max)、D_(mean)差异均无统计学意义(均P>0.05);FIF-IMRT V5_(Gy)低于FFIO-IMRT(P<0.05)。右肺、右乳及脊髓剂量方面,两种计划D_(max)、D_(mean)差异均无统计学意义(均P>0.05)。治疗总跳数方面,FIF-IMRT低于FFIO-IMRT(255.6±5.6比525.8±86.9,P<0.01)。结论与FFIO-IMRT相比,FIF-IMRT虽然靶区均匀性略差、靶区高剂量区体积大,但仍在可控范围内,可满足治疗的要求。FIF-IMRT可有效降低正常组织低剂量辐Objective To explore the dosimertic distribution differences between field-in-field intensity-modulated radiotherapy(FIF-IMRT)and fixed field inversely optimized intensity-modulated radiotherapy(FFIO-IMRT)in left breast cancer after breast-conserving surgery.Methods A total of 10 patients with early left breast cancer after breast-conserving surgery from October 2016 to December 2018 in Jiangsu Cancer Hospital were selected.The radiotherapy plans of FIF-IMRT and FFIO-IMRT were designed.The prescription dosage of breast was 50 Gy,25 times in total,5 times per week and 2 Gy/times.The dose-volume histogram(DVH)was used to compare the dosimetric differences of the planned target volume(PTV),organs at risk and the number of treatment hops in the two plans on the premise that the planned target region met the prescription dosage.Results In terms of PTV,there was no statistically significant difference in conformality index(CI)between the two radiotherapy plans(P>0.05).Uniformity(HI)of FIF-IMRT was higher than that of FFIO-IMRT(0.13±0.02 vs.0.10±0.04,P<0.05).There was no statistically significant difference in the volume ratio(V_(95%)),V_(100%),and maximum radiation dose(D_(max))included in the 95%prescription dosage curve of the two radiotherapy plans(all P>0.05);V105%and the average radiation dose(D_(mean))of FIF-IMRT were higher than that of FFIO-IMRT[(37.63±8.85)%vs.(18.64±5.27)%,(51.81±0.17)Gy vs.(51.37±0.26)Gy,all P<0.05].In terms of heart dosage,the volume ratio(V30_(Gy)),V_(40Gy),and D_(max)of the two plans not less than 30 Gy irradiation were not statistically significant(all P>0.05);V5_(Gy),V10_(Gy),and D_(mean)of FIF-IMRT were lower than those of FFIO-IMRT(all P<0.05).In terms of coronary artery dosage,there was no significant difference in V20_(Gy),V30_(Gy),D_(max),D_(mean)between the two plans(all P>0.05);and V5_(Gy)and V10_(Gy)of FIF-IMRT were lower than those of FFIO-IMRT(all P<0.05).In terms of left ventricle dosage,V20_(Gy),V30_(Gy),V_(40Gy),D_(max)of the two plans were not statistically different

关 键 词：乳腺肿瘤 手术后期间 放射疗法 调强适形 放射治疗剂量 

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