垫高患侧固定方式在左侧乳腺癌术后放射治疗中的临床应用  

Clinical application of raising affected side fixation mode in postoperative radiotherapy of left breast cancer

作　　者：刘裕良[1] 邹金华[1] 胡道坤 刘佳宾[1] 彭金浩 刘忠强 LIU Yuliang;ZOU Jinhua;HU Daokun;LIU Jiabin;PENG Jinhao;LIU Zhongqiang(Department of Radiotherapy,Nanfang Hospital,Southern Medical University,Guangzhou,Guangdong 510515,China)

机构地区：[1]南方医科大学南方医院放射治疗科,广州510515

出　　处：《重庆医学》2023年第14期2148-2153,共6页Chongqing medicine

基　　金：广东省医学科学技术研究基金项目(B2021449)。

摘　　要：目的探讨左侧乳腺癌术后放射治疗中垫高患侧固定方式的可行性,用以降低危及器官(OAR)的受照射剂量。方法收集50例左侧乳腺癌女性患者,随机分成观察组和对照组,每组25例。观察组患者选择垫高患侧的固定方式,对照组为平躺不垫高的固定方式。比较两组患者的摆位误差情况;比较两组患者治疗计划的靶区和OAR的剂量分布情况。结果观察组和对照组的靶区和OAR体积大小无统计学差异。两组患者的摆位误差在左右、前后、上下(X、Y、Z)轴上,差异均无统计学意义(P>0.05)。两组患者的计划靶区(PTV)最小剂量(Dmin)和平均剂量(Dmean)均达到医生要求,差异均无统计学意义(P>0.05)。观察组15例保乳患者中,心脏、右侧乳房、右侧肺和左侧肺的Dmean比对照组15例保乳患者Dmean分别低22.37、20.63、3.26和54.58 cGy,差异具有统计学意义(P值分别为0.039、0.041、0.025、0.036)。观察组10例乳腺切除患者心脏、右侧乳房、右侧肺和左侧肺的Dmean比对照组10例乳腺切除患者的Dmean分别低26.55、28.57、4.09和47.89 cGy,但差异无统计学意义(P值分别为0.084、0.296、0.386、0.277)。结论在左侧乳腺癌保乳术后放射治疗中,采用垫高患侧的固定方式,有助于减少OAR辐射剂量,提高放射治疗增益比。Objective To investigate the feasibility of raising affected side fixation mode to reduce the radiation dose of the organs at risk(OAR)in postoperative radiotherapy for left breast cancer.Methods Fifty female patients with left breast cancer were collected and randomly divided into the observation group and control group,25 cases in each group.The observation group chose the fixed mode by raising the affected side,while the control group adopted the flat down fixed mode without raising.The positioning errors were compared between the two groups.The dose distribution in the target area and OAR of the treatment plan was compared between the two groups.Results The volume sizes of the target area and OAR had no statistical differences between the two groups(P>0.05).The positioning errors in the axises of left and right,front and back,and up and down(X,Y,Z)had no statistical differences between the two groups(P>0.05).The minimum(D min)and average dose(D mean)of PTV target area in the two groups met the requirements of doctors,and there was no statistical difference.Among 15 breast-conserving patients in the observation group,the D mean of heart,right breast,right lung and left lung were lower than those of 15 breast-conserving patients in the control group by 22.37,20.63,3.26,54.58 cGy respectively,and the differences were statistically significant(P=0.039,0.041,0.025,0.036).Among 10 breast-excision patients in the observation group,the D mean of the heart,right breast,right lung and left were lower than those of 10 breast-excision patients in the control group by 26.55,28.57,4.09,47.89 cGy respectively,but the differences were not statistically significant(P=0.084,0.296,0.386,0.277).Conclusion In the postoperative radiotherapy of the left breast-conserving cancer,adopting the raising affected side fixation mode is helpful to reduce the radiation dose of organs at risk and improve the gain ratio of radiotherapy.

关 键 词：左侧乳腺癌 固定方式 危及器官 放射治疗增益比 

分 类 号：R737.9[医药卫生—肿瘤]