乳腺癌术后放疗适用深吸气屏气技术患者筛选的研究进展  

The indicators of selecting patients with breast cancer undergoing postoperative radiotherapy for deep inspiration breath hold technique

作　　者：周莹莹 陈勃[1] 李阳[2] 王斌灏 潘荔生 王宏梅[1] Zhou Yingying;Chen Bo;Li Yang;Wang Binhao;Pan Lisheng;Wang Hongmei(Department of Radiation Oncology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;The First School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院放疗科,广州510515 [2]南方医科大学第一临床医学院,广州510515

出　　处：《中华放射肿瘤学杂志》2023年第2期179-183,共5页Chinese Journal of Radiation Oncology

摘　　要：术后放疗引起的心脏不良反应可增加乳腺癌患者特别是左乳腺癌患者心血管不良事件的发生风险,增加的风险与心脏受照射剂量成正比。深吸气屏气(DIBH)技术已被证明能明显降低左乳腺癌患者的心脏剂量,但不同患者从该技术获益程度差异较大,且该技术的实施需要额外的设备、时间及人力等,所以需要提前筛选出适用该技术的患者。本文全面分析了影响DIBH筛选的定位前一般因素,侧重于系统性总结了CT模拟定位图像相关指标,即CT模拟定位时测量心脏接触距离(CCD_(ps))、心胸距离(HCD)、最大心脏宽度(HW_(max))和最大心脏深度(HD_(max))的乘积,及CT模拟定位后测量最大心脏距离、照射野内心脏体积(HVIF)及自由呼吸(FB)与DIBH状态下肺体积差值及心脏体积差值等解剖学指标。这些指标对评估以切线野为主放疗计划是否采用DIBH技术有指导意义。治疗计划系统中快速计划(RP)功能可快速预测DIBH获益程度。本文旨在帮助临床医生筛选出适合采用DIBH技术的患者,使DIBH技术资源能够被合理利用。Cardiotoxicity caused by postoperative radiotherapy can increase the risk of cardiovascular adverse events in patients with breast cancer,especially those with left breast cancer,which is proportional to the dose of radiation to the heart.It has been proved that deep inspiration breath-hold(DIBH)technique can significantly reduce the cardiac dose in patients with left breast cancer,but the benefits of this technique vary greatly among different patients,and its implementation requires additional equipment,time,manpower and other resources.Hence,it is necessary to select patients who are suitable for this technique in advance.In addition to comprehensive analysis of general factors before simulation positioning that affect DIBH selection,this review also systematically summarized relevant indicators of CT simulation positioning images.These anatomical indicators included the measurement of the cardiac contact distances in parasagittal(CCD_(ps))plane,the lateral heart-to-chest distance(HCD),the product of maximum heart width(HW_(max))and the maximum heart depth(HD_(max))during CT simulation positioning,and the maximum heart distance,heart volume in the irradiation field(HVIF),the difference of lung volume and heart volume between free breathing(FB)and DIBH measured after CT localization.All of them showed some instructive significance for evaluating whether DIBH should be applied in tangent field based radiotherapy planning.The automatic planning(rapid plan)function in the treatment planning system could quickly predict the benefit of DIBH for breast cancer patients.The purpose of this article is to help clinicians select patients who are suitable for DIBH technique,guaranteeing that DIBH technique resources can be used reasonably.

关 键 词：乳腺肿瘤/放射疗法 深吸气屏气 患者筛选 

分 类 号：R737.9[医药卫生—肿瘤]