分段布野方法在乳腺癌根治术后放疗中的应用  

Application of method of segmented fixed-fields in radiotherapy for post-radical mastectomy

作　　者：陈颖 刘茹佳 李玉新 李超 王娟芬 鲁妮娜 杨士勇 CHEN Ying;LIU Rujia;LI Yuxin;LI Chao;WANG Juanfen;LU Nina;YANG Shiyong(Cancer Center,Jingmen No.2 People's Hospital,Hubei Jingmen 448000,China)

机构地区：[1]荆门市第二人民医院肿瘤防治中心,湖北荆门448000

出　　处：《现代肿瘤医学》2021年第24期4392-4397,共6页Journal of Modern Oncology

基　　金：湖北省荆门市一般科技项目(编号:2020YFYB003)。

摘　　要：目的:比较基于常规布野方法与分段布野方法设计的IMRT计划在乳腺癌根治术后放疗中的剂量学差异。方法:选取28例接受放疗的左侧乳腺癌根治术后患者的CT图像,勾画胸壁、腋窝与锁骨上下相关预防照射区域和危及器官,对每例患者分别设计常规布野IMRT计划(CFFIMRT)和分段布野IMRT计划(SFFIMRT),采用SPSS 20.0统计学软件评估两种计划靶区和危及器官剂量学参数及治疗参数的差异。结果:两种计划靶区剂量分布和危及器官受照剂量均满足临床要求,靶区剂量学参数差异无统计学意义(P>0.05);SFFIMRT相对于CFFIMRT,心脏V30降低54.4%(P=0.000)、Dmean降低24.5%(P=0.000),患侧肺V5降低17.6%(P=0.000)、V10降低25.9%(P=0.000)、V20降低9.7%(P=0.000)、Dmean降低14.2%(P=0.000);其它危及器官剂量学参数相当,差异无统计学意义(P>0.05)。SFFIMRT出束时间比CFFIMRT增加10.9%(P=0.000),两种计划机器跳数和子野个数无统计学差异(P>0.05)。结论:SFFIMRT相对于CFFIMRT,出束时间略有增加,但心脏、患侧肺的受照剂量显著降低。从剂量学角度分析,分段布野方法有利于减轻乳腺癌放疗不良反应。Objective:To investigate the dosimetric differences between IMRT plans with conventional fixed-fields and segmented fixed-fields.Methods:28 patients with left post-radical mastectomy who received IMRT were eligible.The chest wall,axilla,supra/infraclavicular region and OARs were delineated.The IMRT plans with conventional fixed-fields(CFF;MRT)and segmented fixed-fields(SFF;MRT)were designed for each patient respectively.The dosimetric parameters of target and OARs and treatment parameters of both plans were compared with SPSS 20.0.Results:The dose distribution for targets and OARs of both plans met clinical requirements.The dosimetric parameters of target of both plans showed no significant statistical difference(P>0.05).Compared with CFF;MRT,the SFF;MRT had significant advantages and the details were as follows:The heart V;54.4%(P=0.000),D;24.5%(P=0.000),and ipsilateral lung V;decreased by 17.6%(P=0.000),V;25.9%(P=0.000),V;9.7%(P=0.000),D;14.2%(P=0.000).The dosimetric parameters of other OARs were not statistically significant(P>0.05).In addition,the delivery time of SFF;MRT increased by 10.9%(P=0.000).The monitor units and number of segment of both plans showed no significant statistical difference(P>0.05).Conclusion:Compared with CFF;MRT,the delivery time of SFF;MRT increased slightly,but exposed dose of heart and ipsilateral lung decreased significantly.From the perspective of dosimetry,SFF;MRT is beneficial to reduce radiotherapy side-effects for breast cancer.

关 键 词：分段布野 乳腺癌根治术后 调强放疗 剂量学参数 放疗不良反应 

分 类 号：R737.9[医药卫生—肿瘤]