保乳术后调强放疗患者3DCT与4DCT的比较研究  

Comparison study of 3DCT and 4DCT in patients treated with intensity-modulated radiotherapy after breast-conserving surgery

作　　者：迪丽胡玛尔·马木提 王雪[1] 唐成琼 艾秀清[1] DILIHUMAER•Mamuti;WANG Xue;TANG Chengqiong;AI Xiuqing(Department of Breast Radiation,The Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830011,China;Department of Radiophysics,The Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院乳腺放疗科,乌鲁木齐830011 [2]新疆医科大学附属肿瘤医院放射物理技术科,乌鲁木齐830011

出　　处：《重庆医学》2023年第17期2577-2581,共5页Chongqing medicine

基　　金：新疆维吾尔自治区科技支疆项目计划(2017E0260)。

摘　　要：目的探讨呼吸运动对乳腺癌患者基于三维CT(3DCT)与四维CT(4DCT)的全乳调强放疗(IMRT)剂量体积参数的影响。方法选取2018年10月至2020年7月该院乳腺放疗科就诊的行保乳术后IMRT的15例患者为研究对象,在平稳呼吸下依顺序进行3DCT及4DCT扫描检查后,依次勾画靶区及危及器官,比较3DCT与4DCT计划靶区及保护器官的剂量学差别。结果计划靶区4DCT因呼吸运动的影响较3DCT减小(36.13 cm^(3) vs.53.35 cm^(3)),差异有统计学意义(P<0.05)。4DCT的D_(95)、D_(90)、D_(min)、V_(100)、V_(95)、V_(90)低于3DCT,而3DCT的适形度指数(CI)、均匀性指数(HI)优于4DCT,差异有统计学意义(P<0.05)。两种计划患侧肺V_(20)、V_(10)、V_(5)、D mean比较,差异无统计学意义(P>0.05);4DCT心脏V_(30)、V_(20)高于3DCT,差异有统计学意义(P<0.05)。结论日常IMRT中应对呼吸运动给予高度重视。Objective To investigate the effect of respiratory exercise on dose-volume parameters of whole breast intensity modulated radiotherapy(IMRT)in breast cancer patients based on three-dimensional CT(3DCT)and four-dimensional CT(4DCT).Methods From October 2018 to July 2020,a total of 15 patients treated in the Department of Breast Radiotherapy in this hospital who underwent IMRT after breast-conserving surgery were selected as the study objects.The target areas and organs at risk were outlined sequentially after 3DCT and 4DCT scans were performed under smooth breathing,and the dosimetric differences between the planned target areas and organs protected by 3DCT and 4DCT were compared.Results The effect of respiratory movement on planned target area of 4DCT was smaller than 3DCT(36.13 cm^(3) vs.53.35 cm^(3)),and the difference was statistically significant(P<0.05).D_(95),D_(90),D_(min),V_(100),V_(95) and V_(90) of 4DCT were lower than those of 3DCT,while conformity index(CI)and homogeneity index(HI)of 3DCT were better than those of 4DCT,and all the differences were statistically significant(P<0.05).There was no significant difference in V_(20),V_(10),V_(5) and D mean on the affected lung between the two plans(P>0.05).Cardiac V_(30) and V_(20) in 4DCT were higher than those in 3DCT,and the difference was statistically significant(P<0.05).Conclusion High priority should be given to respiratory movement in daily IMRT.

关 键 词：乳腺癌 四维CT 调强放射治疗 呼吸运动 危及器官 

分 类 号：R737.9[医药卫生—肿瘤]