乳腺癌根治术后特定射野固定钨门分野静态IMRT与VMAT的临床剂量学评估  

Clinical Dosimetry Evaluation of Static IMRT with Fixed Jaws in Specific Field and VMAT for Breast Cancer after Radical Mastectomy

作　　者：巩汉顺 孟玲玲 解传滨 谷珊珊 王金媛 杨涛 戴相昆 徐寿平 GONG Hanshun;MENG Lingling;XIE Chuanbin;GU Shanshan;WANG Jinyuan;YANG Tao;DAI Xiangkun;Xu Shouping(Department of Radiotherapy,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心放疗科,北京100853

出　　处：《中国医疗设备》2021年第4期113-118,共6页China Medical Devices

基　　金：国家重点研发计划专项(2017YFC0112100);解放军总医院医疗大数据与人工智能研发项目(2019MBD-043)。

摘　　要：目的比较乳腺癌根治术后患者特定射野固定钨门静态调强放疗(Intensity Modulated Radiation Therapy,IMRT)与容积旋转调强放疗(Volumetric Modulated Arc Therapy,VMAT)的剂量学差异。方法选择24例乳腺癌根治术后患者,分别设计IMRT计划与VMAT计划,其中IMRT计划中特定射野对锁骨上区与胸壁区分别采用固定钨门技术进行照射。分别比较两组计划靶区和危及器官的剂量参数、机器跳数和验证通过率。结果VMAT计划的靶区CI及HI结果均优于IMRT计划(P<0.05)。健侧肺V5以下等低剂量区体积参数VMAT计划均高于IMRT计划,而患侧肺V_(10)以上的高剂量区体积参数VMAT计划显著低于IMRT计划(P<0.05)。心脏:左侧乳腺癌患者VMAT计划中V_(5)及以上各体积参数均低于IMRT计划,而右侧乳腺癌患者则呈现相反趋势。VMAT计划的平均MUs少于IMRT计划,尤其是对于左侧乳腺癌患者,具有显著性差异(t=4.18,P<0.05)。结论对于乳腺癌根治术后患者,特定射野固定钨门IMRT计划与VMAT计划皆能满足临床需求,VMAT计划比IMRT计划具有更好靶区的适形度和均匀性;减少了肺组织等危及器官高剂量区的受照体积,但增加了其低剂量区的受照范围;同时降低了MUs,缩短了治疗时间。Objective To compare the dosimetric difference between static intensity modulated radiation therapy(IMRT)with fixed jaws in specific field and volumetric modulated arc therapy(VMAT)in patients with breast cancer after radical mastectomy.Methods A total of 24 patients with breast cancer after radical mastectomy were selected.IMRT plans and VMAT plans were designed respectively.In the IMRT plans,the supraclavicular area and chest wall area were irradiated by fixed jaw technology in specific fields.The dose parameters of the target areas and organs at risk,the number of machine units and the verification pass rate were compared between the two groups.Results The results of CI and HI in target area of the VMAT plan were better than those of the IMRT plan(P<0.05).The volume parameters in low-dose areas below V_(5) of contralateral lung in VMAT plan were higher than those in IMRT plan,while the volume parameters of the high-dose area of the affected lung tissue above V_(10) was significantly lower than the IMRT plan(P<0.05).Heart:the parameters of V5 and above in the VMRT plan for patients with left breast cancer were lower than the IMRT plan.On the other hand,the cardiac parameters of the right breast cancer showed an opposite trend.The average MUs of the VMAT plan was less than that of the IMRT plan,especially for patients with left breast cancer,with significant difference(t=4.18,P<0.05).Conclusion For patients after radical mastectomy for breast cancer,both IMRT plan with fixed jaw in specific field and VMAT plan can meet the clinical needs.The VMAT plan has better target area conformity and uniformity than the IMRT plan,while reduced exposure volume of the high-dose area in lung tissue and other organ at risk,but increased the irradiated range of the lowdose area;at the same time,decreased MUs and shortened the treatment time.

关 键 词：乳腺癌 调强放疗 容积旋转调强放疗 剂量学 

分 类 号：R730.55[医药卫生—肿瘤]