应用Monaco计划系统Surface margin功能提高乳腺癌根治术后胸壁浅表剂量  

Application of Surface margin function of Monaco planning system to increase superficial dose of chest wall after radical mastectomy

作　　者：王秀楠 王钦 褚尚楠 郑倩倩 杨慧 倪文婕 WANG Xiunan;WANG Qin;CHU Shangnan;ZHENG Qianqian;YANG Hui;NI Wenjie(Department of Radiotherapy,Affiliated Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Radiotherapy,Affiliated Beijing Shijingshan Hospital,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京世纪坛医院放疗科,100038 [2]首都医科大学附属北京石景山医院放疗科,100043

出　　处：《重庆医学》2022年第11期1846-1851,共6页Chongqing medicine

基　　金：首都医科大学附属北京世纪坛医院院青年基金(2020-q12)。

摘　　要：目的探讨应用Monaco计划系统表面边距(Surface margin)功能对提高乳腺癌根治术后胸壁浅表剂量的影响。方法将15例女性右侧乳腺癌根治术后患者CT图像分别设计两组计划。一组为使用Surface margin功能的容积旋转调强放疗(VMAT)sm计划组,另一组为不使用Surface margin功能的VMAT计划组。计划靶区(PTV)0定义为临床靶区(CTV)三维外扩5 mm,不超出皮肤。比较两组计划的靶区、浅表区域、危及器官剂量和机器跳数。结果VMAT计划组与VMATsm计划组计划靶区PTV_(0)的适形度指数(CI)分别为0.74±0.03、0.78±0.03,两组比较差异有统计学意义(P<0.001);均匀性指数(HI)分别为0.22±0.04、0.14±0.02,两组比较差异有统计学意义(P<0.001)。浅表区域(Surface)V_(45)分别为(62.69±12.12)%、(94.89±2.53)%,V_(50)分别为(26.15±12.62)%、(66.34±7.47)%,D_(95)分别为(33.78±3.01)、(45.10±0.95)Gy,两组上述指标比较差异有统计学意义(P<0.001)。VMAT计划组与VMATsm计划组左肺平均剂量(D_(mean))分别为(2.03±0.30)、(2.25±0.42)Gy,两组比较差异有统计学意义(P=0.004);两组其他危及器官剂量指标比较,差异均无统计学意义(P>0.05)。VMAT计划组、VMATsm计划组机器跳数分别为(1222±130)、(1295±111)MU,两组比较差异有统计学意义(P=0.045)。结论使用Monaco计划系统Surface margin功能可提高胸壁浅表剂量,且靶区适形度和均匀性更好;除机器跳数及对侧肺D_(mean)有所增加,其他危及器官剂量无明显差异。Objective To explore the effect of using Surface margin function based on the Monaco planning system to increase the superficial dose of chest wall after radical mastectomy.Methods The CT images of 15 patients with right breast cancer after radical mastectomy were selected to design the two groups of plans respectively.One group was the volumetric modulated arc therapy(VMAT)sm plan group which use VMAT of the Surface margin function,while the another group was the VMAT plan group which did not use the Surface margin function.The planning target volume(PTV)_(0) was defined as the clinical target area(CTV)of 5 mm three-dimensional extension,not beyond the skin.The dose of planning target region,superficial area,organ at risk and machine hop were compared between the two groups.Results The conformity index(CI)of planning target volume(PTV_(0))in the VMAT plan group and VMATsm plan group were 0.74±0.03 and 0.78±0.03 respectively,and the difference between the two groups was statistically significant(P<0.001),the homogeneity index(HI)were 0.22±0.04 and 0.14±0.02 respectively,and the differencebetween the two groups was statistically significant(P<0.001).In superficial region(surface),V_(45) was(62.69±12.12)%and(94.89±2.53)%respectively,and the difference between the two groups was statistically significant(P<0.001);V_(50) was(26.15±12.62)%and(66.34±7.47)%respectively,and the difference was statistically significant(P<0.001);D_(95) was(33.78±3.01)Gy and(45.10±0.95)Gy respectively,and the difference was statistically significant(P<0.001).The mean dose of contralateral lung(D_(mean))in the VMAT plan group and VMATsm plan group was(2.03±0.30)Gy and(2.25±0.42)Gy,and the difference between the two groups was statistically significant(P=0.004),but other organs at risk dose indicator had no statistical difference between the two groups(P>0.05).The total monitor units in the VMAT plan group and VMATsm plan group were(1222±130)MU and(1295±111)MU respectively,and the difference was statistically significant(P=0.045

关 键 词：乳腺癌 根治术后 胸壁复发 浅表剂量 表面边距功能 

分 类 号：R730.55[医药卫生—肿瘤]