广义等效均匀剂量优化法在左侧乳腺癌调强放疗中的剂量学研究  

Dosimetric study of generalized equivalent uniform dose optimization method in intensity-modulated radiotherapy for left breast cancer

作　　者：何赟[1] 郭亚[1] 王亚利[1] 许琨[1] 苏王辉 李宇星 HE Yun;GUO Ya;WANG Yali;XU Kun;SU Wanghui;LI Yuxing(Department of Radiotherapy,the Second Affiliated Hospital of Xi'an Jiaotong University,Shannxi Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院放疗科,陕西西安710004

出　　处：《现代肿瘤医学》2021年第21期3825-3829,共5页Journal of Modern Oncology

基　　金：陕西省重点研发计划项目(编号:2020SF-027)。

摘　　要：目的:探讨左侧乳腺癌根治术后调强放疗中广义等效均匀剂量的生物优化法的剂量学优势。方法:选取我院2020年01月到2020年12月30例接受调强放射治疗的左侧乳腺癌患者,每例患者计划靶区均采用剂量-体积的物理优化法;并行危及器官左肺和心脏采用单约束物理优化法(Plan1)、多约束物理优化法(Plan2)以及广义等效均匀剂量的生物优化法(Plan3),右肺、脊髓及其外放的约束条件保持不变,分别评价三组计划的优劣;串行危及器官脊髓及其外放仅采用单约束物理优化法(Plan3)以及广义等效均匀剂量的生物优化法(Plan4),左右肺、心脏的约束条件保持不变,分别评价两组计划的优劣。结果:采用不同优化方法的三组计划Plan1、Plan2和Plan3;以及采用不同优化方法的两组计划Plan3和Plan4靶区的适形度指数CI和均匀性指数HI差异均无统计学意义(P>0.05)。并行危及器官左肺和心脏的剂量Plan3最优,其次是Plan2,最差是Plan1;串行危及器官脊髓及其外放的剂量Plan4优于Plan3且差异均有统计学意义(P<0.05)。结论:广义等效均匀剂量的生物优化法可有效降低危及器官受量且不影响靶区的适形度指数CI以及均匀性指数HI,值得临床中推广使用。Objective:To explore the advantages of generalized equivalent uniform dose optimization method for patients with left breast cancer in post-mastectomy intensity-modulated radiotherapy.Methods:From January 2020 to December 2020,30 patients with left breast cancer who received intensity-modulated radiotherapy were selected.The physical optimization method of dose-volume was used for target area in each patient.The parallel organs at risk of left lung and heart used single-constraint physical optimization method(Plan1),multi-constraints physical optimization method(Plan2)and generalized equivalent uniform dose biological optimization method(Plan3)to evaluate the advantages and disadvantages of the three groups with right lung,spinal cord and extraspinal cord constriants unchanged.The serial organs at risk of spinal cord and extraspinal cord only used single-constraint physical optimization method(Plan3)and generalized equivalent uniform dose biological optimization method(Plan4)to evaluate the advantages and disadvantages of the two groups with left lung,right lung and heart constriants unchanged.Results:There was no statistically difference among the Plan1,Plan2 and Plan3,and no statistically difference between the Plan3 and Plan4 in conformal index CI and uniformity index HI of the target area with different optimization methods(P>0.05).The dose of Plan3 was best followed by Plan2,the Plan1 was worst for parallel organs at risk of left lung and heart.The dose of Plan4 was better than Plan3 for serial organs at risk of spinal cord and extraspinal cord and the difference had statistically significant(P<0.05).Conclusion:Generalized equivalent uniform dose biological optimization method can effectively reduce the dose of organs at risk and without affecting the conformal index CI and uniformity index HI of the target area,and it is worthy popularizing in clinic.

关 键 词：单约束物理优化法 多约束物理优化法 广义等效均匀剂量 生物优化法 剂量 

分 类 号：R737.9[医药卫生—肿瘤]