不同手术类型对乳腺癌放射治疗精确度的影响  

Effect of Different Surgical Types on the Accuracy of Radiotherapy for Breast Cancer

作　　者：高梦圆 陈新佳[1] 朱鹭超[1] 林勤[1] 陈泽杰 GAO Mengyuan;CHEN Xinjia;ZHU Luchao;LIN Qin;CHENZejie(Department of Radiation Oncology,the First Affiliated Hospital of Xiamen University,Xiamen Fujian 361000,China)

机构地区：[1]厦门大学附属第一医院肿瘤放疗科,福建厦门361000

出　　处：《中国卫生标准管理》2024年第7期140-144,共5页China Health Standard Management

基　　金：福建省自然科学基金项目(2020J011220)。

摘　　要：目的研究乳腺癌改良的根治性乳房切除术(根治)、早期保乳手术(保乳)、假体植入3种手术类型对其放射治疗精确度的影响,为不同手术类型的患者制定个性化放疗方案。方法随机选择2023年2—7月就诊于厦门大学附属第一医院肿瘤放射治疗科行旋转调强治疗的乳腺癌放射治疗患者37例进行回顾性分析,其中乳腺根治患者13例,保乳患者11例,假体植入患者13例。每例患者除首次锥形束CT(Cone beam CT,CBCT)复位外,每5天在治疗前采集1次CBCT,并与定位图像进行配准,记录腹背(ventral-dorsal,VRT)、头脚(cranial-caudal,LNG)、左右(lateral,LAT)3个方向的误差值。共收集误差数据150组,其中根治61组,保乳38组,假体植入51组,并对误差进行分析。结果根治组在三维方向的摆位误差分别为:VRT[-1.80(-3.20,-0.20)]mm,LNG[-2.20(1.10,3.05)]mm,LAT[-3.30(-1.10,1.65)]mm,保乳组在三维方向的摆位误差分别为:VRT[-0.20(-1.03,1.03)]mm,LNG[1.40(-2.20,3.00)]mm,LAT[0.15(-3.05,2.90)]mm,假体植入组在三维方向的摆位误差分别为:VRT[-1.00(-3.00,0.70)]mm,LNG[-1.00(-3.00,1.80)]mm,LAT[0(-2.00,2.80)]mm,对3组数据进行K个独立样本的非参数检验和事后多重比较显示,根治组和保乳组在VRT方向比较,差异有统计学意义(P<0.05)。3组在LNG,LAT方向上比较,差异无统计学意义(P>0.05)。3组不同手术类型在三维方向上的计划靶区(planning target volume,PTV)边界分别为根治组(4.18,6.19,7.52 mm),保乳组(4.71,6.53,8.01mm),假体植入组(6.17,7.53,6.29 mm)。结论不同手术类型对乳腺癌放射治疗精确度影响不同,在VRT方向上根治组的摆位误差大于保乳组,可根据不同的手术类型个性化选择固定方式以提高患者的摆位精确度。除此之外,每个肿瘤中心可根据不同的手术类型计算适合自己中心的PTV外扩范围以给予临床医生建议。Objective To study the effect of three types of surgery on the accuracy of radiotherapy for breast cancer:modified radical mastectomy(radical mastectomy),early breast conserving surgery(breast conserving surgery),and prosthesis implantation,and to develop personalized radiotherapy programs for patients with different types of surgery.Methods A total of 37 patients with breast cancer undergoing VMAT in the First Affiliated Hospital of Xiamen University from May 2023 to July 2023 were randomly selected and retrospectively analyzed,including 13 patients with radical mastectomy,11 patients with breast conservation,and 13 patients with prosthesis implantation.In addition to the first CBCT reduction,each patient will collect CBCT every five days before treatment and register it with the positioning image,recording the error values in three directions:ventral dorsum(VRT),head and foot(LNG),and left and right(LAT).A total of 150 sets of error data were collected,including 61 groups for radical treatment,38 groups for breast preservation,and 51 groups for prosthesis implantation,and the error was analyzed.Results The positioning errors in the three-dimensional direction of the radical treatment group were:VRT:[-1.80(-3.20,-0.20)]mm,LNG:[-2.20(1.10,3.05)]mm,LAT:[-3.30(-1.10,1.65)]mm,the positioning errors in the three-dimensional direction of the breast conserving group were:[-0.20(-1.03,1.03)]mm,LNG[1.40(-2.20,3.00)]mm,LAT[0.15(-3.05,2.90)]mm,and the positioning errors in the three-dimensional direction of the implant group were:VRT[-1.00(-3.00,0.70)mm],LNG[-1.00(-3.00,1.80)mm],LAT[0(-2.00,2.80)mm],respectively.Kruskal-Wallis test and post HOC multiple comparisons were conducted on the three sets of data,and it was found that the radical treatment group and breast conserving group had a statistically significant difference of in the VRT direction(P<0.05),while in the LNG and LAT directions,there was no statistically significant difference in the three sets of data(P>0.05).The planning target volume(PTV)boundaries in the t

关 键 词：乳腺癌 手术类型 放射治疗 摆位误差 PTV边界 旋转调强治疗 

分 类 号：R737[医药卫生—肿瘤]