乳腺癌改良根治术后两种调强放疗技术的甲状腺辐射剂量学评价  

Thyroid dosimetry evaluation of two intensity-modulated radiotherapy techniques after modified radical mastectomy for breast cancer

作　　者：孙丽云 沈磊[1] 张顺康 卢月 陈刚[1] SUN Liyun;SHEN Lei;ZHANG Shunkang;LU Yue;CHEN Gang(Department of Radiation Oncology,Huangpu Branch,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院黄浦分院放疗科,上海200011

出　　处：《中国临床医学》2024年第6期959-965,共7页Chinese Journal of Clinical Medicine

基　　金：上海市黄浦区临床研究类科研项目(HLM202114).

摘　　要：目的比较左乳腺癌改良根治术后调强放疗(IMRT)和容积旋转调强放疗(VMAT)中甲状腺辐射剂量学特点。方法选择2021年12月至2023年5月在上海交通大学医学院附属第九人民医院黄浦分院放疗科接受左乳腺癌改良根治术后辅助放疗的30例患者,分别采用IMRT和VMAT,靶区处方剂量均为50 Gy/25次。比较2种计划的靶区剂量学参数,以及危及器官剂量体积限量(Vx,x表示受照剂量)和平均剂量(Dmean)等。结果VMAT靶区适形度优于IMRT(P<0.001)。与VMAT相比,IMRT中心脏V5、V10、Dmea n和右肺V5、右侧乳腺Dmea n较小,左肺V20较大(P<0.001)。IMRT与VMAT中左侧甲状腺V5、V10差异无统计学意义;IMRT中左侧甲状腺及全甲状腺V20、V30、V40、Dmean和右侧甲状腺V10、Dmean均小于VMAT(P<0.001)。结论IMRT和VMAT技术均能满足临床辐射剂量学要求,其中采用IMRT患者的甲状腺受照剂量更小,且IMRT更适用于心脏条件要求高的患者。Objective To compare the dosimetric characteristics of thyroid between intensity-modulated radiotherapy(IMRT)and volumetric modulated arc therapy(VMAT)in patients with left-sided breast cancer after modified radical mastectomy.Methods Thirty patients with left-sided breast cancer who underwent adjuvant radiotherapy after modified radical mastectomy at the Huangpu Branch of the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,from December 2021 to May 2023,were selected as the study subjects,and IMRT and VMAT were used with a target prescription dose of 50 Gy/25 times.The target dose parameters of the two plans,including the mean dose(Dmean)and the dose-volume limit for organs at risk(Vx,x represents dose),were compared.Results The conformity index of VMAT was higher than that of IMRT(P<0.001).Compared with VMAT,IMRT plan significantly reduced the V5、V10、Dmean of heart,the V5 of right lung and the Dmean of right breast,while it significantly increased the V20 of left lung(P<0.001).There was no statistically significant difference in V5 and V10 of the left thyroid between IMRT and VMAT.However,the V20,V30,V40,and Dmean of left and whole thyroid,and the V10 and Dmean of right thyroid were significantly lower in IMRT than those in VMAT(P<0.001).Conclusions Both IMRT and VMAT plans can meet the clinical dosimetric requirements,among which IMRT has lower thyroid exposure dose and is more suitable for patients with high cardiac requirements.

关 键 词：甲状腺 乳腺癌 调强放疗 容积旋转调强放疗 辐射剂量学 

分 类 号：R737.9[医药卫生—肿瘤]