左乳腺癌保乳术后瘤床同步加量静态调强放射治疗与断层定野放射治疗的剂量学研究  

Dosimetric study of sIMRT and TOMO fixed field irradiation(TD)simultaneous integrated boost on tumor bed for patients receiving left breast-conserving surgery

作　　者：刘梦岚 吉维 赵彪 文晓博 袁美芳 杨毅 Meng-lan Liu;Wei Ji;Biao Zhao;Xiao-bo Wen;Mei-fang Yuan;Yi Yang(Department of Radiation Oncology,Tumor Hospital of Yunnan Province(The Third Affiliated Hospital of Kunming Medical University),Kunming,Yunnan 650118,China)

机构地区：[1]云南省肿瘤医院(昆明医科大学第三附属医院)放疗科,云南昆明650118

出　　处：《中国现代医学杂志》2022年第11期73-78,共6页China Journal of Modern Medicine

基　　金：云南省卫生科技项目(No:2017NS192)。

摘　　要：目的探讨左乳腺癌保乳术后瘤床同步加量静态调强放射治疗(sIMRT)与断层定野放射治疗(TD)的剂量学特点。方法选取2016年5月-2018年5月云南省肿瘤医院左乳腺癌保乳术后瘤床银夹标记患者24例,对同一患者分别采用sIMRT计划设计(Monaco5.11.03治疗计划系统)和TD计划设计(TomoTherapy治疗计划系统),比较两种计划的剂量学参数。结果两组计划的肿瘤计划靶区(PGTV)的D_(2%)、D_(98%)、适形指数(CI)、均匀性指数(HI)比较,差异均有统计学意义(P<0.05),sIMRT的CI(0.75±0.05)高于TD的CI(0.61±0.13),TD的HI(0.04±0.01)低于sIMRT的HI(0.05±0.00)(P<0.05)。D_(50%)组间差异无统计学意义(P>0.05)。两组计划的乳腺计划靶区(PTV)的D_(98%)、CI、HI比较,差异均有统计学意义(P<0.05),sIMRT的CI(0.82±0.04)高于TD的CI(0.68±0.05),TD的HI(0.19±0.01)低于sIMRT的HI(0.20±0.01)(P<0.05),D_(2%)、D_(50%)组间差异均无统计学意义(P>0.05)。在危及器官的比较上,sIMRT较TD降低了左肺的V_(5)、V_(20)、D_(mean)以及左右心室的D_(mean)(P<0.05),其中sIMRT左肺的V_(5)、V_(20)和D_(mean)较TD分别降低了3.69%、1.26%、7.84%。TD较sIMRT降低了对侧乳腺的D_(mean)、心脏的V30、左右心房的D_(mean)及脊髓的D_(2%)(P<0.05)。但在心脏的D_(mean)方面两者组间差异无统计学意义(P>0.05)。结论sIMRT技术和TD技术均能满足左乳腺癌保乳术后放疗的剂量需求,sIMRT技术的CI优于TD技术的CI,TD技术的HI优于sIMRT技术的HI;sIMRT技术对患侧肺的保护更佳,对于有肺部基础疾病的患者,建议优先选择sIMRT技术;TD技术对心脏的保护并未体现出明显优势。Objective To discuss the dosimetric characteristics of simultaneous integrated boost sIMRT and TD on the tumor bed after breast-conserving surgery for left breast cancer.Methods Twenty-four patients who were marked by silver clips on the tumor bed after breast-conserving surgery for left breast cancer were selected.For the same patient,the Monaco5.11.03 treatment planning system was used for the sIMRT plan design,and the Tomo Therapy treatment planning system was used for the TD plan design.The dosimetry parameters of the two plans were compared.Results The differences in D_(2%),D_(98%),CI,and HI of planned tumor planning target volume(PGTV)between the two groups were statistically significant(P<0.05).The CI of sIMRT(0.75±0.05)was higher than that of TD(0.61±0.13),and the HI of TD(0.04±0.01)was lower than sIMRT(0.05±0.00)(P<0.05).The difference in D_(50%)was not statistically significant(P>0.05).The differences in D_(98%),CI,and HI of the breast plan target volume(PTV)between the two groups were statistically significant(P<0.05).The CI of sIMRT(0.82±0.04)was higher than that of TD(0.68±0.05),and the HI of TD(0.19±0.01)was lower than sIMRT(0.20±0.01)(P<0.05).The difference in D_(2%),D_(50%)was not statistically significant(P>0.05).In comparison with organs at risk,compared with TD,sIMRT reduced V_(5),V_(20),D_(mean)in the left lung and,D_(mean)in the left and right ventricles(P<0.05).The V_(5),V_(20)and D_(mean)of the left lung of sIMRT were reduced by 3.69%,1.26%,and 7.84%respectively,compared with TD.Compared with sIMRT,TD reduced the D_(mean)of the contralateral breast,V30 of the heart,D_(mean)of the left and right atrium,and D_(2%)of the spinal cord(P<0.05).However,there was no statistically significant difference in the D_(mean)of the heart(P>0.05).Conclusion Both sIMRT technology and TD technology can meet the dose requirements of postoperative radiotherapy for left breast cancer.The CI of the former is better than the latter,and the HI of the latter is better than the former;sIMRT technology can bet

关 键 词：乳腺癌 保乳术 静态调强放射治疗 断层定野放射治疗 剂量学 

分 类 号：R737.9[医药卫生—肿瘤]