左乳癌保乳术后4种放疗计划的剂量学比较  

Dosimetric comparison of left sided breast cancer after breast conserving surgery treated with 4 radiotherapy planning techniques

作　　者：任洪荣[1] 殷海涛[1] 阮晓博 丁纪[1] 周冲[1] 陈猛[1] REN Hongrong;YIN Haitao;RUAN Xiaobo;DING Ji;ZHOU Chong;CHEN Meng(Department of Radiotherapy,Xuzhou Cental hospital,Xuzhou 221000 China)

机构地区：[1]徐州市中心医院放疗科,江苏徐州221000

出　　处：《中国辐射卫生》2021年第3期345-349,共5页Chinese Journal of Radiological Health

摘　　要：目的比较左侧乳腺癌保乳术后行全乳放射治疗时4种放射治疗计划的靶区及危机器官剂量学差异,探讨保乳术后较优的放疗治疗方式。方法随机选取23例左侧乳腺癌术后行全乳放射放疗患者,给予PTV 25分·次、50 Gy处方剂量;分别设计适形混合调强计划(Hybrid_IMRT)、限制铅门多野调强计划(restricted jaw,rj_IMRT)、双弧容积旋转调强计划(VMAT)和基于切线双弧容积旋转调强计划(tangent-based VMAT,t_VMAT)4种放疗计划。比较这4种计划的剂量学差异,包括靶区及危及器官OAR的剂量-体积直方图DVH,靶区均匀性指数HI和适形性指数CI以及机器跳数MU。结果 4种计划比较,靶区HI:t_VMAT最大,且与其余3种计划相比有差异统计学意义(均P <0.001);靶区CI:VMAT的CI最大,0.967±0.016,与其它3者相比,差异有统计学意义(均P <0.05)。rj_IMRT的CI为0.942±0.018,优于Hybrid_IMRT和t_VMAT。危及器官方面:左肺平均剂量,rj_IMRT为(8.76±1.52) Gy,优于其他3种计划,且差异有统计学意义(均P <0.05)。心脏平均剂量:rj_IMRT为(4.68±0.87) Gy,优于VMAT的(6.90±1.27) Gy,且有统计学意义(P <0.05)。结论 4种计划方式均可应用于临床治疗,计划制定者应考虑治疗设备限制、患者身体状况等因素选择合适的治疗计划。Objective To explore the optimal radiotherapy method by comparing the dosimetric differences of target and organs at risk of four radiotherapy plans for left sided breast cancerafter breast-conserving surgery.Methods Twenty-three patients with left breast cancer were randomly selected and given PTV 25 fractions,50 Gy prescription dose.TheHybrid_IMRT,rj_IMRT,VMAT and t_VMAT plans were designed for each patients.Dosimetric differences were compared,including dose volume histograms of target and OARs,target homogeneity indexes(HI),conformal indexes(CI)and the machine MUs.Results Target Dosimetric comparison,HI:t_VMAT plan target has highest HI and had significant difference(P≤0.001);The target CI of VMAT plans were 0.967±0.016,had significant difference compared with the other 3 plans(P<0.05).The CI of rj_IMRT were 0.942±0.018 better than that of IMRT and t_VMATs.Dosimetric comparison of OARs,left_lung mean dose(MLD_L):rj_IMRT were(8.76±1.52)Gy which were best of 4 plans,and had statistical significance(P<0.05).Heart mean dose:rj_IMRT were(4.68±0.87)Gy were better than that of VMAT(P<0.05).Conclusion All of these four plans could be applied in clinical treatments,while the limitations of treatment equipment,patients’physical conditions and some other factors should be considered before selecting an appropriate one.

关 键 词：保乳术 调强放射治疗 剂量学比较 

分 类 号：R816[医药卫生—放射医学]