不同射野方式在左乳腺癌术后放射治疗中的剂量学研究  

Dosimetric study of different radiation field methods in postoperative left-sided breast cancer radiotherapy

作　　者：王君辉 刘福友 葛彬彬[1] 曹顾飞 金建华[1] 储开岳[1] 刘海涛[1] WANG Jun-hui;LIU Fu-you;GE Bin-bin;CAO Gu-fei;JIN Jian-hua;CHU Kai-yue;LIU Hai-tao(Nantong Tumor Hospital,Tumor Hospital Affiliated to Nantong University,Nantong 226361,Jiangsu,China)

机构地区：[1]南通市肿瘤医院,南通大学附属肿瘤医院,江苏南通226361

出　　处：《生物医学工程与临床》2022年第6期733-737,共5页Biomedical Engineering and Clinical Medicine

基　　金：南通市卫生健康委员会青年项目(QA2020019)。

摘　　要：目的探讨3种不同射野方式在术后左乳腺癌放射治疗计划中对剂量学的影响分析。方法选择25例左乳腺癌术后放射治疗患者,年龄28~76岁,中位年龄48岁。利用Monaco计划系统Auto Flash Margin技术,分别设计7野调强放射治疗(7FIMRT)、9野调强放射治疗(9FIMRT)、部分双弧的容积旋转调强放射治疗(VMAT)的治疗计划,处方剂量均为50 Gy/25F,设计均满足临床要求。评估分析3组计划靶区和危及器官的剂量学参数,即靶区剂量、靶区适形度指数(CI)、靶区均匀性指数(HI)和危及器官剂量体积比,以及机器出束跳数和机器出束时间等。结果部分双弧VMAT靶区D_(mean)[(52.74±73.00)Gy]高于7FIMRT[(51.65±28.00)Gy]和9FIMRT[(51.18±41.00)Gy](P均<0.05),9FIMRT靶区适形度和均匀性均优于7FIMRT和部分双弧VMAT(P<0.05);对危及器官,部分双弧VMAT在全肺、患侧肺及健侧肺的V_(5)[(23.27±4.37)%、(51.60±5.16)%、(2.16±1.34)%],全肺和健侧肺的D_(mean)明显降低[(6.61±0.73)Gy、(1.22±0.11)Gy](P<0.05)、9FIMRT患侧肺的V20有降低[(22.23±1.38)%](P<0.05);部分双弧VMAT的心脏D_(mean)[(5.09±0.52)Gy]均分别低于7FIMRT[(6.14±0.27)Gy]和9FIMRT[(6.71±0.31)Gy](P<0.05);部分双弧VMAT的机器出束跳数和机器出束时间均分别明显小于7FIMRT和9FIMRT[(288±21)s vs(399±17)s、(453±13)s](P<0.05)。结论3种计划设计均能满足左乳腺癌术后放射治疗患者的临床需求,其中9FIMRT在靶区适形度和均匀性略优,但部分双弧VMAT在保护危及器官、计划治疗跳数和治疗时间上具有一定的优势,建议选择部分双弧VMAT技术,能够在保证患者计划质量的同时节省医疗资源,具有较高的临床应用价值。Objective To investigate the effects of 3 radiation field methods on dosimetry in postoperative radiotherapy planning for left-sided breast cancer.Methods A total of 25 patients with postoperative left-sided breast cancer were enrolled,which aged 28-76 years old with median age of 48 years old.The Auto Flash Margin technology was used to design 7-field intensity-modulated radiotherapy(7FIMRT),9-field intensity-modulated radiotherapy(9FIMRT)and partial double-arc volu metric modulated arc therapy(VMAT)plans,the prescribed doses were 50 Gy/25 F,and all designs met clinical requirements.The dosimetric parameters of 3 groups planned target volumes and organs at risk were evaluated and analyzed,including target volume dose,target volume conformity index(CI),target volume homogeneity index(HI),organ at risk dose-volume ratio,num-ber of monitor unit(MU)and execution time.Results The D_(mean)of partial double-arc VMAT target area[(52.74±73.00)Gy]was higher than that of 7FIMRT[(51.65±28.00)Gy]and 9FIMRT[(51.18±41.00)Gy](P<0.05),and the conformity as well as uniformity of 9FIMRT target area were significantly better than those of 7FIMRT and partial double-arc VMAT(P<0.05).For organs at risk,partial double-arc VMAT V_(5)in total pulmonary,ipsilateral lung and contralateral lung[(23.27±4.37)%,(51.60±5.16)%,(2.16±1.34)%],D_(mean)of total pulmonary and contralateral lung[(6.61±0.73)Gy,(1.22±0.11)Gy](P<0.05)were significantly decreased,and 9FIMRT V20of ipsilateral lung was significantly decreased[(22.23±1.38)%](P<0.05).The partial double-arc VMAT cardiac D_(mean)[(5.09±0.52)Gy]was significantly lower than that of 7FIMRT[(6.14±0.27)Gy]and 9FIMRT[(6.71±0.31)Gy](P<0.05);MU number and execution time of partial double-arc VMAT were significantly less than that of7FIMRT and 9FIMRT[(288±21)seconds vs(399±17)seconds,(453±13)seconds](P<0.05).Conclusion It is demonstrated that the 3 plan designs all meet clinical needs of postoperative left-side breast cancer patients with radiotherapy,9FIMRT is slightly better in target c

关 键 词：乳腺癌 调强放射治疗 容积旋转调强治疗 剂量学 

分 类 号：R737.9[医药卫生—肿瘤]