乳腺癌保乳术后IMRT和3DCRT的剂量学比较  

Dosimetric comparison between IMRT and 3DCRT after breast-conserving surgery for breast cancer

作　　者：董晓庆[1] 胡杰[1] 林清[1] DONG Xiaoqing;HU Jie;LIN Qing(Department of Radiotherapy,Tenth People’s Hospital of Tongji University,Shanghai 200072,China)

机构地区：[1]同济大学附属第十人民医院放射治疗科,上海200072

出　　处：《重庆医学》2023年第9期1373-1378,共6页Chongqing medicine

基　　金：同济大学附属第十人民医院临床研究培育项目(05.12.20613)。

摘　　要：目的比较调强放疗(IMRT)技术和三维适形放疗(3DCRT)技术在乳腺癌保乳术后放疗的剂量学差异。方法选取2017年8月至2019年9月在该院行保乳术后放疗的乳腺癌患者80例,同一影像分别设计IMRT和3DCRT计划,对比评估靶区均匀性指数(HI)、适形度指数(CI)、2%、98%靶区体积所受照剂量(D_(2)、D_(98)),以及患侧肺、健侧肺、心脏、脊髓和乳头的剂量。结果与3DCRT技术相比,IMRT技术下全乳腺计划靶区(PTV)、瘤床加量计划靶区(PTVb)的HI降低,CI升高,PTV抠除PTVb区域(PTV-PTVb)的D_(2)、PTV-PTVb中接近处方剂量1.1倍的体积(V_(55))降低[V_(55):145.10(100.84,227.25)cm^(3) vs.247.84(183.35,353.12)cm^(3)],差异均有统计学意义(P<0.05)。与3DCRT技术相比,IMRT技术下患侧肺3000、2000 cGy照射的体积百分比(V_(30)、V_(20))和平均剂量(D_(mean))降低,心脏4000 cGy照射的体积百分比(V_(40))、V_(30)和D_(mean)降低,乳头的最大剂量(D_(max))、D_(mean)降低,脊髓的D_(max)升高,差异均有统计学意义(P<0.05)。结论与3DCRT技术相比,IMRT技术在乳腺癌保乳术后放疗中更能提高靶区均匀性和适形度,降低靶区高剂量区体积,更好地保护危及器官。Objective To compare the dosimetric difference between intensity-modulated radiotherapy(IMRT)and three dimensional conformal radiotherapy(3DCRT)after breast conserving surgery for breast cancer.Methods A total of 80 cases of patients with breast cancer after conserving surgery in the hospital from August 2017 to September 2019 were selected.IMRT and 3DCRT plans were designed for the same image.The homogeneity index(HI),conformal index(CI),doses received by 2%and 98%of the planning target volume(D_(2),D_(98))were compared and evaluated,as well as the doses of the ipsilateral lung,the contralateral lung,the heart,the spinal cord and the nipple.Results Compared with the 3DCRT technology,the HI of the whole breast planning target volume(PTV)and tumor bed boost planning target volume(PTVb)decreased and the CI increased under the IMRT technology,the D_(2) of PTV-PTVb,and the volume(V_(55))of the PTVPTVb,which was close to 1.1 times of the prescribed dose,decreased[V_(55):145.10(100.84,227.25)cm^(3) vs.247.84(183.35,353.12)cm^(3)],the differences were statistically significant(P<0.05).Compared with the 3DCRT technology,the volume percentage receiving 3000 cGy and 2000 cGy(V_(30),V_(20)),and the _mean) dose(D_(mean))of ipsilateral lung decreased.The volume percentage receiving 4000 cGy(V_(40)),V_(30) and D_(mean) of heart,the maximum dose(D_(max))and D_(mean) of nipple decreased,D_(max) of spinal cord increased under the IMRT technology,the differences were statistically significant(P<0.05).Conclusion Compared with 3DCRT technology,IMRT technology can increase the homogeneity and conformability of the target,reduce the volume of high-dose area in the target area and better protect organ at risk in the radiotherapy after breast conserving surgery for breast cancer.

关 键 词：乳腺癌 调强放射治疗 三维适形放射治疗 剂量学 危及器官 

分 类 号：R737.9[医药卫生—肿瘤]