乳腺癌术后放疗H-IMRT技术与H-VMAT技术剂量学比较  

Comparison of dosimetry between H-IMRT and H-VMAT techniques in postoperative radiotherapy of breast cancer

作　　者：徐丙臣 曹洋森 李健[3] XU Bingchen;CAO Yangsen;LI Jian(Department of Radiation Therapy,Jilin Central Hospital,Jilin 132011,China;Department of Radiation Oncology,Changhai Hospital of Naval Medical University;Department of Radiation Therapy,Guangdong Agriculture Reclamation Central Hospital)

机构地区：[1]吉林市中心医院放疗科,吉林132011 [2]海军军医大学第一附属医院放疗科 [3]广东省农垦中心医院放疗科

出　　处：《实用肿瘤学杂志》2021年第6期511-516,共6页Practical Oncology Journal

摘　　要：目的比较基于IMRT的混合调强计划(H-IMRT)与基于VMAT的混合容积调强计划(H-VMAT)在左侧乳腺癌根治术后(胸壁+锁骨上+内乳区)放射治疗计划的剂量学参数,为复杂的乳腺癌术后放疗计划设计提供一定的参考。方法选取我院2018年1月—2020年12月,20例左侧乳腺癌根治术后患者。所有患者胸壁、锁骨上淋巴结、内乳淋巴结均需要接受放射治疗,每个患者分别设计制作H-IMRT与H-VMAT两种放疗计划。CRT射野对胸廓方向进行2 cm的多叶准直器(MLC)外放。靶区处方剂量50 Gy,通过剂量计算比较靶区和危及器官的剂量参数。结果H-IMRT计划靶区均匀性指数为(0.13±0.06),适形指数为(1.33±0.08)。H-VMAT计划靶区均匀性指数为(0.12±0.04),适形指数为(1.24±0.07)。H-VMAT计划中靶区均匀性指数和适形指数均高于H-IMRT计划(P<0.05)。H-IMRT计划患肺V5(48.99±2.91)%、V20(24.5±1.1)%,H-VMAT计划患肺V5(45.87±3.53)%、V20(20.6±1.6)%,H-VMAT计划患肺V5和V20剂量均低于H-IMRT计划(P<0.05)。H-IMRT计划心脏V30(10.44±3.62)%、V40(6.59±3.53)%,H-VMAT计划心脏V30(5.87±1.53)%、V40(4.9±2.8)%,H-VMAT计划心脏V30和V40均低于H-IMRT计划(P<0.05)。H-IMRT计划心脏Dmean(7.43±1.78)Gy,H-VMAT计划心脏Dmean(9.7±0.7)Gy,H-VMAT计划略高于H-IMRT计划(P<0.05)。结论对于带有内乳淋巴结的乳腺癌术后放疗靶区,H-VMAT对比H-IMRT靶区适形度更好,危及器官受照剂量更低。Objective The aim of this study was to compare the dosimetric parameters of the mixed intensity-modulated plan(H-IMRT)and the mixed volume-modulated plan(H-VMAT)after radical mastectomy for left breast cancer(chest wall+supraclavicular+internal mammary area),and provide a certain reference for the design of complex breast cancer postoperative radiotherapy plans.Methods Twenty patients with left breast cancer who underwent radical surgery in our hospital from January 2018 to December 2020 were selected.All patients received radiotherapy on the chest wall,supra-clavicular lymph nodes,and internal mammary lymph nodes.Each patient was designed and made two radiotherapy plansH-IMRT and H-VMAT.In the CRT field,a 2 cm multi-leaf collimator(MLC)was placed in direction of the chest.The prescription dose of the target area was 50 Gy,and the dose parameters of the target area and the organ at risk were compared through the dose calculation.Results The uniformity index for the target area of H-IMRT plan was(0.13±0.06),and the conformity index was(1.33±0.08).The uniformity index for the target area of H-VMAT plan was(0.12±0.04),and the conformity index is(1.24±0.07).The uniformity index and conformity index of the target area in the H-VMAT plan were higher than those in the H-IMRT plan(P<0.05).H-IMRT plan suffered from lung V5(48.99±2.91)%and V20(24.5±1.1)%;H-VMAT plan suffered from lung V5(45.87±3.53)%and V20(20.6±1.6)%.The doses of V5 and V20 suffered from lung in H-VMAT plan were lower than those of H-IMRT plan(P<0.05).H-IMRT plan suffered from heart V30(10.44±3.62)%and V40(6.59±3.53)%;H-VMAT plan suffered from heart V30(5.87±1.53)%and V40(4.9±2.8)%.H-VMAT plan heart V30 and V40 Lower than H-IMRT(P<0.05).The doses of V30 and V40 suffered from the heart in the H-VMAT were better than those of H-IMRT.H-IMRT plan for heart was Dmean(7.43±1.78)Gy and H-VMAT plan was Dmean(9.7±0.7)Gy.The Dmean of the heart in the H-VMAT was slightly higher than that of H-IMRT(P<0.05).Conclusion For the postoperative radiotherapy t

关 键 词：调强放射治疗 容积调强放射治疗 常规切线野 

分 类 号：R735.7[医药卫生—肿瘤]