左侧乳腺癌保留乳房手术后不同腋窝勾画方法的剂量学特点  

Dosimetric analysis of two contour guidelines for left breast cancer after breast conservingg surgery

作　　者：倪文婕 王秀楠 葛永青 刘骁蕾 穆晓峰 NI Wenjie;WANG Xiunan;GE Yongqing;LIU Xiaolei;MU Xiaofeng(Department of Radiation Oncology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院放疗科,北京100038

出　　处：《中华肿瘤防治杂志》2024年第9期563-568,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：首都医科大学附属北京世纪坛医院院青年基金(2020-q12)。

摘　　要：目的评估左侧乳腺癌保留乳房手术后美国肿瘤放射治疗协作组(RTOG)和欧洲放射肿瘤学会(ESTRO)指南腋窝勾画方法的剂量学特点,比较其优缺点,为临床提供参考。方法选取2020-09-01-2021-10-31首都医科大学附属北京世纪坛医院放疗科收治的16例左侧乳腺癌保留乳房手术后患者,根据ESTRO和RTOG指南分别勾画腋窝淋巴引流区和全乳。ESTRO指南腋窝2组和胸肌间淋巴引流区合并勾画,并命名为腋窝Ⅱ组,腋窝3组命名为腋窝Ⅲ组,第4组淋巴结命名为锁骨上区,分别设计PTV-E(ESTRO指南)和PTV-R(RTOG指南)计划,处方剂量为50 Gy/25 f,记录各计划相关剂量学参数。应用SPSS 23.0软件,两组间比较采用配对t检验。结果ESTRO和RTOG指南的腋窝Ⅱ组体积分别为(46.0±11.1)cm^(3)和(16.6±4.7)cm^(3)(t=12.461,P<0.001),左锁骨上体积分别为(11.5±2.6)cm^(3)和(29.1±7.4)cm^(3),t=-9.465,P<0.001。PTV-E计划的患侧肺D_(mean)、V_(5)、V_(20)和V_(30)分别为(8.9±0.9)Gy、(40.2±3.2)%、(13.9±2.5)%和(8.7±2.0)%,PTV-R计划分别为(8.2±1.0)Gy、(37.6±4.1)%、(12.1±2.4)%和(7.6±2.0)%,均P<0.05;PTV-E和PTV-R计划甲状腺平均剂量分别为(11.4±7.4)Gy和(27.3±4.2)Gy,t=-7.392,P<0.001;臂丛神经最大剂量分别为(54.4±0.7)Gy和(54.3±1.0)Gy(t=0.122,P=0.904),V_(30)分别为(32.1±11.1)%和(73.5±13.2)%(t=-7.964,P<0.001),V_(50)分别为(20.7±8.9)%和(31.0±17.8)%,t=-2.284,P=0.037。结论两种指南勾画方法危及器官受照剂量均满足临床需要,ESTRO指南勾画的锁骨上淋巴引流区更小,临近的甲状腺及臂丛神经受照剂量更低。Objective To evaluate the dosimetric characteristics of two contour guidelines by RTOG and ESTRO for left breast cancer after breast conserving surgery.Methods From September 1,2020 to October 31,2021,16 consecutive left breast cancer after breast conserving surgery were enrolled.According to the ESTRO and RTOG guidelines,the regional lymph node areas and whole breast were delineated.For comparison,in the ESTRO guideline,axilla level 2 and interpec-toral nodes were delineated together,and named as axilla levelⅡ,axilla level 3 named as axilla levelⅢ,and lymph node level 4 named as supraclavicular.Each patient designed two volume modulated arc therapy plannings:PTV-E(ESTRO guideline)and PTV-R(RTOG guideline).The prescription dose was 50 Gy per 25 fractions,and the relevant dosimetric parameters of each plan were recorded.SPSS 23.0 software was used for statistical analysis.The two groups were com-pared by paired t-test.Results The volume of axilla levelⅡaccording to ESTRO and RTOG guidelines were(46.0±11.1)cm^(3)and(16.6±4.7)cm^(3)(t=12.461,P<0.001).The volume of supraclavicular according to ESTRO and RTOG guidelines were(11.5±2.6)cm^(3)and(29.1±7.4)cm^(3)(t=-9.465,P<0.001).The mean dose,V_(5),V_(20),V_(30) to ipsi-lateral lung in the PTV-E plan were(8.9±0.9)Gy,(40.2±3.2)%,(13.9±2.5)%and(8.7±2.0)%,respectively,compared to(8.2±1.0)Gy,(37.6±4.1)%,(12.1±2.4)%and(7.6±2.0)%in the PTV-R plan(all P<0.05).The mean doses of thyroid in the PTV-E and PTV-R plans were(11.4±7.4)Gy and(27.3±4.2)Gy,respectively(t=-7.392,P<0.001).The maximum doses to the brachial plexus nerve in the PTV-E and PTV-R plans were(54.4±0.7)Gy and(54.3±1.0)Gy,respectively(t=0.122,P=0.904),V_(30) were(32.1±11.1)%and(73.5±13.2)%,re-spectively(t=-7.964,P<0.001),and V_(50) were(20.7±8.9)%and(31.0±17.8)%,respectively(t=-2.284,P=0.037).Conclusion The exposure doses of organ at risk for both contour guidelines meet clinical needs.The volume of supraclavicular nodes according to the ESTRO guideline is smaller,and the doses of thyroid a

关 键 词：乳腺肿瘤/放射疗法 腋窝淋巴结/放射疗法 靶区勾画 指南 剂量学 

分 类 号：R730.55[医药卫生—肿瘤] R737.9[医药卫生—临床医学]