肺体积分段优化技术对乳腺癌根治术后VMAT的剂量学影响研究  

Dosimetry impact of lung segmentation on volumetric modulated arc therapy after radical mastectomy for breast cancer

作　　者：罗佳 肖何 刘岩海 耿明英 周鹏 LUO Jia;XIAO He;LIU Yan-hai;GENG Ming-ying;ZHOU Peng(Oncology Department,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院肿瘤科,重庆400042

出　　处：《医疗卫生装备》2022年第12期36-40,75,共6页Chinese Medical Equipment Journal

基　　金：国家重点研发计划项目(2018YFC0114402)。

摘　　要：目的 :比较在乳腺癌根治术后容积旋转调强放射治疗(volumetric modulated arc therapy,VMAT)计划设计时采用肺体积分段技术与不采用肺体积分段技术的剂量学差异。方法:回顾性选取40例乳腺癌根治术后患者,采用Monaco治疗计划系统为每位患者设计2个VMAT计划,使用肺体积分段技术进行限制的计划作为试验组,未采用肺体积分段技术的计划作为对照组,2组在相同函数配置和参数设置下进行逆向优化,比较2组在计划靶区(planning target volume,PTV)、危及器官的剂量学参数和机器跳数方面的差异。采用SPSS 24.0软件进行统计学分析。结果:试验组PTV的D98低于对照组(P<0.05),均匀性指数(heterogeneity index,HI)和适形性指数(conformity index,CI)高于对照组(P<0.05);对于左侧乳腺癌,试验组表现出更优的患侧肺和心脏保护,对于右侧乳腺癌,试验组表现出更优的患侧肺保护;试验组的机器跳数显著高于对照组(P<0.05)。结论:在乳腺癌根治术后VMAT计划设计时,采用肺体积分段技术能有效控制肺、心脏的受照射体积和剂量。Objective To compare the dosimetric differences between volumetric modulated arc therapy(VMAT) plan design with and without lung segmentation after radical mastectomy. Methods Forty patients after radical mastectomy were retrospectively selected, and two VMAT plans were designed for each patient using Monaco treatment planning system, with the plans using lung segmentation for restriction enrolled into an experimental group and the ones without the technique into a control group. Reverse optimization was carried out for the two groups with the same function configuration and parameter settings. The two groups were compared in terms of planning target volume(PTV), dosimetric parameters of organs at risk and monitor unit. SPSS 24.0 software was used for statistical analysis. Results The experimental group had the D98of PTV lower than that of the control group(P<0.05), while the values of the heterogeneity index(HI) and conformity index(CI) higher(P<0.05);for left-sided breast cancer the experimental group gained advantages in protecting the affected lung and heart, and for right-sided breast cancer the experimental group behaved better in the protection of the affected lung;the experimental group had the monitor unit better than that of the control group(P<0.05). Conclusion The lung segmentation can effectively control the irradiated volume and dose to lung and heart when designing VMAT plans after radical mastectomy.

关 键 词：乳腺癌根治术 VMAT 肺体积分段 剂量学 计划优化 

分 类 号：R318[医药卫生—生物医学工程] R815[医药卫生—基础医学]