乳腺癌脑转移容积旋转调强放疗对海马保护效果及认知功能的影响  

Effect of volumetric modulation arc therapy on hippocampal protection and cognitive function in breast cancer patients with brain metastases

作　　者：王聪 张志林[1] 李锦秋 宋晓[1] 席强[1] 马欢[1] 庞永鹏 WANG Cong;ZHANG Zhilin;LI Jinqiu(Department of Radiotherapy,the First Affiliated Hospital of Hebei North University,Hebei,Zhangjiakou 075000,China;不详)

机构地区：[1]河北北方学院附属第一医院放射治疗科,河北省张家口市075000 [2]天津二七二医院放射科

出　　处：《河北医药》2024年第20期3084-3087,3091,共5页Hebei Medical Journal

基　　金：河北省医学科学研究课题计划项目(编号:20220595)。

摘　　要：目的探讨乳腺癌脑转移容积旋转调强放疗对海马保护效果及认知功能的影响。方法选取2021年8月至2022年8月首次就诊的乳腺癌脑转移瘤患者20例。随机分为调强放疗(IMRT)组10例和容积旋转调强放疗(VMAT)组10例。评估2组计划的剂量体积直方图(DVH)、适形度指数(CI)、均匀指数(HI)、加速器跳数(MU)、海马限制区域(HA)等正常组织,及其治疗前、治疗结束、治疗后1个月及3个月的简易智能精神状态检查量表(MMSE)。结果在DVH图中,VMAT组的PTV-HA平均剂量[(31.71±0.06)vs(31.38±0.08)]、D98[(29.54±0.24)vs(27.78±0.63)]、D95[(30.21±0.12)vs(29.65±0.51)]、D2[(32.91±0.02)vs(32.82±0.12)]、D50[(31.79±0.06)vs(31.56±0.10)]均高于IMRT组,差异有统计学意义(P均<0.05);VMAT组中95%、100%、105%的PTV-HA处方剂量所占的体积均高于IMRT组,差异有统计学意义(P均<0.05)。与IMRT组相比,VMAT组的CI值增加,而HI值、MU值及治疗时间均减少(P均<0.05)。在正常组织剂量受限中,VMAT组患者的HA平均剂量[(8.46±0.24)vs(8.67±0.11)]和最大剂量[(13.51±1.04)vs(14.57±1.19)]、双眼最大剂量[(22.39±0.64)vs(25.78±0.43)]均小于IMRT组(P均<0.05)。放疗结束后随访,在治疗后3个月比较中,2组MMES评分差异有统计学意义[(24.95±1.41)vs(23.31±1.85),P=0.039]。结论VMAT相对IMRT在乳腺癌脑转移中可能具有更优的靶体积剂量覆盖,更佳的海马保护,一定程度上可能延缓患者的认知功能障碍。Objective To investigate the effect of volumetric modulation arc therapy on hippocampal protection and cognitive function in breast cancer patients with brain metastases.Methods A total of 20 breast cancer patients with brain metastases who were initially treated from August,2021 to August,2022 were enrolled.They were randomly assigned into the intensity-modulated radiation therapy(IMRT)group and volumetric modulation arc therapy(VMAT)group,with 10 cases per group.The dose-volume histogram(DVH),conformity index(CI),homogeneity index(HI),machine unit(MU),hippocampal avoidance(HA)and other normal tissues of two groups were evaluated.The Mini-Mental State Examination(MMSE)before and immediately after the treatment,and 1 month and 3 months after the treatment was evaluated.Results In the DVH images,the planning target volume with hippocampal avoidance(PTV-HA,31.71±0.06 vs.31.38±0.08),D98%(dose received by 98%of target volume;29.54±0.24 vs.27.78±0.63),D95%(dose received by 95%of target volume;30.21±0.12 vs.29.65±0.51),D2%(dose received by 2%of target volume;32.91±0.02 vs.32.82±0.12),and D50%(dose received by 50%of target volume;31.79±0.06 vs.31.56±0.10)were significantly higher in the VMAT group than those of IMRT group(all P<0.05).The volume of 95%,100%,105%of PTV-HA prescription dose in the VMAT group were significantly higher than those of the IMRT group(all P<0.05).Compared to IMRT group,a significantly increased CI,but significantly decreased HI,MU and treatment time were detected in the VMAT group(all P<0.05).In normal tissue dose limitation,the mean HA dose(8.46±0.24 vs.8.67±0.11),maximum dose(13.51±1.04 vs.14.57±1.19),and maximum dose to both eyes(22.39±0.64 vs.25.78±0.43)were all significantly lower in the VMAT group than the IMRT group(all P<0.05).At post-radiotherapy follow-up visits,there was a significant difference in the MMSE score at 3 months between the two groups([24.95±1.41]points vs.[23.31±1.85]points,P=0.039).Conclusion Compared with IMRT,VMAT may have a better target volume dose

关 键 词：乳腺癌脑转移 容积旋转调强放疗 海马回避 简易智能精神状态检查量表 

分 类 号：R730.55[医药卫生—肿瘤]