左侧乳腺癌保乳术后质子与光子放疗剂量学对比研究  

Comparative study of dosimetry between proton and photon radiotherapy after breast conserving surgery for left breast cancer

作　　者：龙腾飞 闻妹 马涛[1] 刘鹤飞 柳璐 李骁扬 张红雁 LONG Tengfei;WEN Mei;MA Tao;LIU Hefei;LIU Lu;LI Xiaoyang;ZHANG Hongyan(Department of Radiation Oncology,Ion Medical Center,the First Affiliated Hospital of USTC(Hefei Ion Medical Center),Hefei 230088,China;不详)

机构地区：[1]中国科学技术大学附属第一医院离子医学中心(合肥离子医学中心)放疗科,合肥230088 [2]中国科学技术大学附属第一医院(安徽省立医院)放疗科

出　　处：《中国临床保健杂志》2024年第3期381-386,共6页Chinese Journal of Clinical Healthcare

摘　　要：目的比较在深吸气屏气呼吸模式(DIBH)下左侧乳腺癌保乳术后光子调强放疗(IMRT)、质子调强放疗(IMPT)剂量学差异。方法选取2020年11月至2022年5月中国科学技术大学附属第一医院离子医学中心(合肥离子医学中心)在DIBH模式下接受左侧乳腺癌保乳术后放疗的7例女性患者病历资料,计划靶区(PTV)处方剂量均为50 Gy(5周,25次),对于影像学(包括功能性影像)上高度怀疑有残留或复发病灶的区域局部加量至PTV_(boost):60 Gy。分别在瓦里安Eclipse 15.5计划系统上设计IMRT计划和Eclipse 16.1计划系统上设计IMPT计划。对2组计划靶区剂量分布、适形指数(CI)、均匀性指数(HI)、两侧肺、健侧乳腺(右乳)、心脏及左冠状动脉前降支(LAD)照射剂量进行统计分析。结果质子与光子放疗计划相比,PTV最大剂量(D_(max))(P=0.389)和平均剂量(D_(mean))(P=0.044)、PTV_(boost) D_(max)(P=0.226)和D_(mean)(P=0.018)、CI(P=0.035)和HI(P=0.419)、患侧肺部(左侧)D_(max)(P=0.153)、健侧肺(右肺)D_(max)(P=0.318)和D_(mean)(P=0.046)、心脏D_(max)(P=0.014)、LAD D_(max)(P=0.025)、健侧乳腺(右乳)D_(max)(P=0.097)均和光子计划无差异。但质子计划左侧肺D_(mean)(P<0.01)、V_(5)(P<0.001)、V_(20)(P<0.001)及心脏D_(mean)(P<0.001)、LAD D_(mean)(P<0.001)、健侧乳腺(右乳)D_(mean)(P=0.010)均明显低于光子计划。结论DIBH下左侧乳腺癌保乳术后质子和光子计划均满足临床要求。但采用质子放疗可显著降低对心脏及其亚单位、患侧肺和健侧乳腺的照射剂量。Objective To compare photon-modulated radiation therapy(IMRT)and proton-modulated radiation therapy(IMPT)after breast-conserving surgery for left breast cancer under deep inspiratory breath-hold(DIBH)dosimetry differences.Methods A total of 7 female patients who received postoperative radiotherapy for left breast cancer in DIBH mode from November 2020 to May 2020 at the First Affiliated Hospital of USTC(Hefei Ion Medical Center)were selected.The planing target volume(PTV)was prescribed at 50 Gy(5 weeks,25 times),and the local dose was increased to PTV_(boost):60 Gy for areas with high imaging(including functional imaging)suspicion of residual or recurrent lesions.The IMRT plan was designed on the Varian Eclipse 15.5 plan system and the IMPT plan was designed on the Eclipse 16.1 plan system,respectively.The dose distribution,conformal index(CI),homogeneity index(HI),bilateral lungs,healthy breast gland(right breast),heart and left anterior descending coronary artery(LAD)of the two groups of planned targets were analyzed statistically.Results Proton versus photon radiation,the maximum dose(D_(max))of PTV(P=0.389)and the mean dose(D_(mean))(P=0.044),D_(max) of PTV_(boost)(P=0.226)and D_(mean)(P=0.018),CI(P=0.035)and HI(P=0.419),D_(max) of affected lung(left lung)(P=0.153),D_(max) of healthy lung(right lung)(P=0.318)and D_(mean)(P=0.046),D_(max) of heart(P=0.014),D_(max) of LAD(P=0.025)and D_(max) of healthy side breast(right breast)D_(max)(P=0.097)were all the same as those in the photon program.However,the left lung D_(mean)(P<0.01),V_(5)(P<0.001),V_(20)(P<0.001)of the affected side(left lung)of the proton program;D_(mean) of heart(P<0.001);D_(mean) of LAD(P<0.001);D_(mean) of healthy side breast(right breast)(P=0.010)were significantly lower than those of the photon program.Conclusions Both proton and photon programs after breast-conserving surgery for left breast cancer under DIBH meet clinical requirements.However,proton radiotherapy can significantly reduce the irradiation dose to the heart and its subunits,the

关 键 词：乳腺肿瘤 质子疗法 光子疗法 放射治疗剂量 

分 类 号：R737.9[医药卫生—肿瘤]