基于内缘切线野的调强放疗与容积弧形调强放疗在左侧乳腺癌保乳术后放疗中的剂量学研究  

Dosimetric study of intensity-modulated radiotherapy and volumetric intensity modulated arc therapy based on the inner edge tangent field for radiotherapy after breast-conserving surgery of left-sided breast cancer

作　　者：赵彪 蒲琴 袁美芳 马立双 李瀚 杨毅[1] 孙朝细 Zhao Biao;Pu Qin;Yuan Meifang;Ma Lishuang;Li Han;Yang Yi;Sun Chaoxi(Department of Radiotherapy,Peking University Cancer Hospital Yunnan,Yunnan Cancer Hospital,Third Affiliated Hospital of Kunming Medical University,Kunming 650118,China;Department of Critical Care Medicine,Peking University Cancer Hospital Yunnan,Yunnan Cancer Hospital,Third Affiliated Hospital of Kunming Medical University,Kunming 650118,China)

机构地区：[1]北京大学肿瘤医院云南医院,云南省肿瘤医院,昆明医科大学第三附属医院放射治疗科,昆明650118 [2]北京大学肿瘤医院云南医院,云南省肿瘤医院,昆明医科大学第三附属医院重症医学科,昆明650118

出　　处：《国际肿瘤学杂志》2024年第7期441-447,共7页Journal of International Oncology

基　　金：国家自然科学基金(81760423)。

摘　　要：目的探究左侧乳腺癌保乳术后基于内缘切线野(IETF)的调强放疗(IMRT)与容积弧形调强放疗(VMAT)的剂量学差异。方法选取2022年6月至2023年6月收治于云南省肿瘤医院放射治疗科的35例左侧乳腺癌保乳术后行IMRT患者的定位CT和靶区危及器官(OAR)等资料,针对同一患者分别设计基于IETF的IMRT和VMAT两种放疗计划,IETF-IMRT和IETF-VMAT;对两种放疗计划的靶区和OAR剂量及计划执行时间进行比较。结果靶区剂量:IETF-IMRT和IETF-VMAT两种放疗计划靶区的D98%分别为(47.92±0.51)、(48.21±0.33)Gy,D_(50%)分别为(52.04±0.22)、(51.91±0.26)Gy,D_(2%)分别为(53.93±0.36)、(53.62±0.41)Gy,适形指数分别为0.84±0.03、0.87±0.02,均匀性指数分别为0.12±0.01、0.10±0.01,差异均有统计学意义(t=-3.87,P<0.001;t=3.53,P=0.001;t=5.30,P<0.001;t=-13.60,P<0.001;t=6.24,P<0.001)。OAR剂量:IETF-IMRT和IETF-VMAT两种放疗计划左肺V_(5)分别为(31.91±6.28)%、(33.99±6.31)%,V_(20)分别为(11.71±2.06)%、(9.73±2.12)%,差异均有统计学意义(t=-4.18,P<0.001;t=12.40,P<0.001);右肺V_(5)分别为(0.11±0.08)%、(7.13±3.12)%,D_(_(mean))分别为(1.05±0.12)、(2.71±0.27)Gy,差异均有统计学意义(t=-33.62,P<0.001;t=-13.30,P<0.001);脊髓D_(2%)分别为(1.08±0.11)、(4.83±1.40)Gy,差异有统计学意义(t=-15.99,P<0.001)。左肺D_(mean)分别为(7.45±1.08)、(7.37±1.03)Gy,心脏D_(mean)分别为(4.21±0.96)、(4.41±0.48)Gy,右侧乳腺D_(mean)分别为(3.74±1.52)、(3.48±1.11)Gy,差异均无统计学意义(t=1.16,P=0.253;t=-1.76,P=0.088;t=1.41,P=0.169)。计划执行时间:IETF-IMRT和IETF-VMAT两种放疗计划执行时间分别为(10.73±1.21)、(2.18±0.17)min,差异有统计学意义(t=44.71,P<0.001)。结论IETF-IMRT和IETF-VMAT均能满足临床要求,但两种技术各有特点。靶区适形性和均匀性方面,IETF-VMAT略优;两种计划的OAR剂量均显著低于乳腺癌术后放疗剂量限值,其中,IETF-IMRT计划的左肺V_(5),右肺V_(5)、D_(mean)和脊髓D_(2%)略�Objective To explore the dosimetry difference between intensity-modulated radiotherapy(IMRT)and volumetric intensity modulated arc therapy(VMAT)based on the inner edge tangent field(IETF)after left-sided breast conserving surgery.Methods The localization CT and target organ at risk(OAR)data of 35 patients with left-sided breast cancer treated with IMRT after breast conserving surgery at Department of Radiotherapy in Yunnan Cancer Hospital from June 2022 to June 2023 were selected.The IETF-IMRT and the IETF-VMAT plans were designed for the same patient based on IETF,the dosimetry differences of target areas and OAR,as well as the planned execution time were compared between the two groups.Results Dosimetry of target areas:for IETF-IMRT and IETF-VMAT,the D98%of the planning target volume were(47.92±0.51)and(48.21±0.33)Gy,respectively,while the D_(50%)were(52.04±0.22)and(51.91±0.26)Gy,respectively,and the D_(2%)were(53.93±0.36)and(53.62±0.41)Gy,respectively,the conformity index were 0.84±0.03 and 0.87±0.02,respectively,while the homogeneity index were 0.12±0.01 and 0.10±0.01,respectively,with statistically significant differences(t=-3.87,P<0.001;t=3.53,P=0.001;t=5.30,P<0.001;t=-13.60,P<0.001;t=6.24,P<0.001).Dosimetry of OAR:for IETF-IMRT and IETF-VMAT,the left lung V_(5) were(31.91±6.28)%and(33.99±6.31)%,respectively,and the V_(20) were(11.71±2.06)%and(9.73±2.12)%,respectively,with statistically significant differences(t=-4.18,P<0.001;t=12.40,P<0.001).The right lung V_(5) were(0.11±0.08)%and(7.13±3.12)%,respectively,and the D_(mean) were(1.05±0.12)and(2.71±0.27)Gy,respectively,with statistically significant differences(t=-33.62,P<0.001;t=-13.30,P<0.001).The spinal cord D_(2%)were(1.08±0.11)and(4.83±1.40)Gy,respectively,with a statistically significant difference(t=-15.99,P<0.001).The left lung D_(mean) were(7.45±1.08)and(7.37±1.03)Gy,the heart D_(mean) were(4.21±0.96)and(4.41±0.48)Gy,and the right-sided breast D_(mean) were(3.74±1.52)and(3.48±1.11)Gy,respectively,with no statistically signi

关 键 词：乳腺肿瘤 内缘切线野 乳腺癌保乳术后 调强放疗 容积弧形调强放疗 剂量学 

分 类 号：R737.9[医药卫生—肿瘤]