乳腺癌保乳术后放疗中根据金属夹或血清肿勾画瘤床靶区对瘤床位置确定的意义  

Significance of target volume delineation of tumor bed according to metal clips or seroma in determing tumor bed position during radiotherapy after breast-conserving surgery for breast cancer

作　　者：姚智敏 倪文婕 侯栋梁 王子红 陈文彰 Yao Zhimin;Ni Wenjie;Hou Dongliang;Wang Zihong;Chen Wenzhang(Department of Radiotherapy,Shijingshan Teaching Hospital of Capital Medical University,Beijing Shijingshan Hospital,Beijing 100040,China;Department of Radiotherapy,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Oncology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]首都医科大学石景山教学医院、北京市石景山医院放疗科,北京100040 [2]首都医科大学附属北京世纪坛医院放疗科,北京100038 [3]中国中医科学院广安门医院肿瘤科,北京100053

出　　处：《肿瘤研究与临床》2023年第1期23-28,共6页Cancer Research and Clinic

摘　　要：目的探讨乳腺癌保乳术后放疗中根据术中放置的金属夹与根据CT扫描中的血清肿勾画瘤床靶区的差异,探寻更优的瘤床位置确定方案。方法选取2020年12月至2022年1月于北京市石景山医院及首都医科大学附属北京世纪坛医院保乳术后放疗的早期乳腺癌患者13例进行回顾性研究。分别根据术中放置的金属夹勾画瘤床靶区(GTVtb-Clip)、CT扫描血清肿勾画瘤床靶区(GTVtb-Seroma)及以二者共同为参考勾画瘤床靶区(GTVtb-C+S),比较靶区之间体积、三维方向长径、中心点位移及适形度的差异。结果GTVtb-Clip、GTVtb-Seroma、GTVtb-C+S的体积分别为(25±10)cm^(3)、(38±17)cm^(3)、(49±20)cm^(3),三者之间差异均有统计学意义(均P<0.05)。GTVtb-Clip、GTVtb-Seroma、GTVtb-C+S在X轴的长径分别为(4.7±1.2)cm、(5.3±1.4)cm、(5.7±1.6)cm,在Y轴的长径分别为(4.6±1.7)cm、(5.0±1.6)cm、(5.7±1.7)cm,在Z轴的长径分别为(4.4±1.5)cm、(5.2±1.4)cm、(5.6±1.4)cm;GTVtb-Clip和GTVtb-C+S间X、Y、Z轴上的长径差异均有统计学意义(均P<0.05),GTVtb-Seroma和GTVtb-C+S间X、Z轴上的长径差异均有统计学意义(均P<0.05),GTVtb-Clip和GTVtb-Seroma间X轴上的长径差异有统计学意义(P<0.05)。GTVtb-Clip、GTVtb-Seroma、GTVtb-C+S中心点位移分别为(5.8±1.6)cm、(5.5±1.9)cm、(6.0±1.7)cm,三者间差异无统计学意义(P>0.05)。GTVtb-Clip和GTVtb-Seroma间、GTVtb-Clip和GTVtb-C+S间、GTVtb-Seroma和GTVtb-C+S间的适形度分别为0.412±0.112、0.525±0.095、0.774±0.112,差异均有统计学意义(均P<0.05)。结论乳腺癌保乳术后放疗中,与单独根据血清肿或金属夹勾画瘤床靶区相比,二者联合能更全面地覆盖真实的瘤床,减少瘤床的漏照,从而降低复发率。建议保乳术后的放疗患者选择术后4~8周进行CT定位,同时参考金属夹和血清肿等术后改变来勾画瘤床靶区。Objective To investigate the differences between the mental clips placed intraoperatively and the tumor bed's target volume delineation of seroma based on CT scanning during radiotherapy for breast cancer patients who received breast-conserving surgery in the persuit of a better solution to determine the tumor bed position.Methods The clinical data of 13 patients with early breast cancer who received postoperative radiotherapy after breast-conserving surgery at Beijing Shijingshan Hospital and Beijing Shijitan Hospital of Capital Medical University from December 2020 to January 2022 were retrospectively analyzed.They all had surgical clips implanted during the surgery.The following methods were used to delineate the target volume of tumor bed,including gross target volume delineation of tumor bed based on the mental clips(GTVtb-Clip),the tumor bed's gross target volume delineation of seroma based on CT scanning(GTVtb-Seroma),and the combination of both(GTVtb-C+S).The volume,diameter on three coordinate axis,neutral point displacement and conformability of these delineation methods were compared.Results The volume of GTVtb-Clip,GTVtb-Seroma and GTVtb-C+S was(25±10)cm^(3),(38±17)cm^(3),(49±20)cm^(3),and the differences were statistically significant(all P<0.05).The diameter on X axis was(4.7±1.2)cm,(5.3±1.4)cm,(5.7±1.6)cm,respectively in GTVtb-Clip,GTVtb-Seroma and GTVtb-C+S;the diameter on Y axis was(4.6±1.7)cm,(5.0±1.6)cm,(5.7±1.7)cm,respectively in GTVtb-Clip,GTVtb-Seroma and GTVtb-C+S;the diameter on Z axis was(4.4±1.5)cm,(5.2±1.4)cm,(5.6±1.4)cm in GTVtb-Clip,GTVtb-Seroma and GTVtb-C+S.The differences in the diameter of GTVtb-Clip and GTVtb-C+S on X,Y,Z axis were statistically significant(all P<0.05);the differences in the diameter of GTVtb-Seroma and GTVtb-C+S on X,Z axis were statistically significant(all P<0.05);the difference in the diameter of GTVtb-Clip and GTVtb-Seroma on X axis was statistically significant(P<0.05).Neutral point displacement was(5.8±1.6)cm,(5.5±1.9)cm,(6.0±1.7)cm,respecti

关 键 词：乳腺肿瘤 乳房切除术 区段 外科器械 血清肿 放射治疗 图像引导 

分 类 号：R737.9[医药卫生—肿瘤]