乳腺托架在乳腺癌保乳术后容积调强放疗中的应用  

Application of Breast Bracket in Volumetric Modulated Arc Therapy After Breast Conserving Surgery

作　　者：朱斌 程冬 刘文敏 付振明[1] ZHU Bin;CHENG Dong;LIU Wenmin;FU Zhenming(Tumor Center,Renmin Hospital of Wuhan University,Wuhan Hubei 430027,China)

机构地区：[1]武汉大学人民医院肿瘤中心,湖北武汉430027

出　　处：《中国医疗设备》2023年第8期38-42,85,共6页China Medical Devices

基　　金：国家自然科学基金项目(81773555)。

摘　　要：目的 探讨切线弧容积调强放疗(Volumetric Modulated Arc Therapy,VMAT)中乳腺托架摆位方式对危及器官(Organs at Risk,OARs)特别是心肺的防护作用是否优于一体架摆位方式。方法 收集2021年12月至2022年9月于我院进行乳腺癌保乳术后辅助放疗的患者40例,按摆位方式分为一体架摆位组(A组)和乳腺托架摆位组(B组),每组20例。A组患者每例患者设计A-1和A-2两个放疗计划,其中A-1组准直器角度为0,A-2组设置合适的准直器角度;B组患者仅设计一个放疗计划,准直器角度为0。比较各组靶区和OARs的剂量分布。结果 靶区剂量指标中,B组的均匀性指数优于A-1组、A-2组,治疗时间长于A-1组、A-2组,差异有统计学意义(P<0.05);B组与A-1组、A-2组患者D2%、D98%、靶区适形度、机器跳数比较,差异均无统计学意义(P>0.05)。患者各OARs的剂量学差异主要体现在低剂量区。B组患侧肺的V5和V10、健侧乳腺的V5和Dmean以及心脏的V5剂量均低于A-1组、A-2组,差异有统计学意义(P<0.05);高剂量区如V20和V30等指标,B组与A-1组、A-2组患者差异无统计学意义(P>0.05)。A-1组与A-2组仅右侧乳腺癌患者的肝脏V5差异有统计学意义(P<0.05),其他OARs剂量比较,差异均无统计学意义(P>0.05)。结论 乳腺癌保乳术后辅助切线弧VMAT放疗中,乳腺托架摆位方式较一体架摆位方式具有更好的OARs保护作用。Objective To explore whether the protective effect of breast bracket placement mode in volumetric modulated arc therapy(VMAT)on organs at risk(OARs),especially heart and lung is better than that of body bracket positioning.Methods A total of 40 patients who underwent adjuvant radiotherapy after breast conserving surgery from December 2021 to September 2022 in our hospital were collected and divided into two groups:body bracket positioning group(group A)and breast bracket positioning group(group B)according to the placement mode,with 20 patients in each group.Two radiotherapy plans were designed for each patient in group A:group A-1 and group A-2,in which the collimator angle of group A-1 was 0,and the appropriate collimator angle of group A-2 was set.In group B,only one radiotherapy plan was designed and the collimator angle was 0.The dose distribution of target area and OARs in each group was compared.Results Comparing the target dose indexes of the two groups,the heterogeneity index of group B was better than that of group A-1 and group A-2,and the treatment time was longer than that of group A-1 and group A-2,the differences were statistically significant(P<0.05).There was no statistically significant difference in D2%,D98%,conformity index,and the number of machine units among group B,group A-1,and group A-2 patients(P>0.05).The dosimetry differences of patients’OARs were mainly reflected in low-dose areas.The doses of V5 and V10 in the affected lung,V5 and Dmean in the healthy mammary gland,and V5 in the heart of group B were lower than those of group A-1 and group A-2,the differences were statistically significant(P<0.05).There was no significant difference in high dose areas such as V20 and V30 among group B,group A-1,and group A-2 patients(P>0.05).There was statistically significant difference only the V5 doses of the liver in the right breast cancer patients between A-1 and group A-2(P<0.05),and there was no statistically significant difference in other OARs(P>0.05).Conclusion In adjuvant VMAT after br

关 键 词：乳腺癌 乳腺托架 摆位方式 危及器官 容积调强放疗 

分 类 号：R144[医药卫生—公共卫生与预防医学] R730.55