早期乳腺癌保乳术后大分割放疗瘤床补量方式剂量学比较  

Dosimetry Comparision of Tumor Bed Boosting Modalities in Hypofractionated Radiotherapy Following Breast-Conserving Surgery for Early-Stage Breast Cancer

作　　者：叶明月 马瑞[1] 艾郁葱[1] 张晶[1] 李诗扬 张淼 赵玲[1] YE Mingyue;MA Rui;AI Yucong;ZHANG Jing;LI Shiyang;ZHANG Miao;ZHAO Ling(Jilin Cancer Hospital,Changchun 130000,China)

机构地区：[1]吉林省肿瘤医院,吉林长春130000

出　　处：《肿瘤学杂志》2024年第11期932-938,共7页Journal of Chinese Oncology

基　　金：吉林省卫生健康科技能力提升项目(2021LC123)。

摘　　要：[目的]通过亚组分析对早期乳腺癌保乳术后大分割瘤床同步补量(simultaneous integrated boost,SIB)及序贯补量(sequential boost,SEB)的剂量学参数进行比较,旨在为早期乳腺癌保乳术后大分割放疗瘤床补量方式的选择提供剂量学方面的参考。[方法]2021年10月至2023年8月共入组了44例符合条件的早期乳腺癌保乳术后患者,采用容积旋转调强放疗(volumetric modulated arc therapy,VMAT)和螺旋断层放射治疗(Tomo therapy,TOMO)两种放疗技术。其中,SIB 19例(TOMO 11例,VMAT 8例),SEB 25例(TOMO 9例,VMAT 16例)。SIB计划的瘤床计划体积(planning target volume boost,PTVboost)处方剂量为48.0 Gy,3.2 Gy/15 f,PTV处方剂量为40.05 Gy,2.67 Gy/15 f;SEB计划的PTVboost处方剂量为52.2 Gy,2.9 Gy/18 f,PTV处方剂量为43.5 Gy,2.9 Gy/15 f。对靶区及危及器官各评价参数应用两独立样本t检验及非参数秩和检验进行统计学分析。[结果]与TOMO-SEB相比较,TOMO-SIB中PTV、PTV-PTVboost的V107均显著性降低(38.89%±10.58%vs 59.87%±21.49%,t=-2.854,P=0.011;32.90%±12.35%vs 52.22%±17.89%,t=-2.852,P=0.011),PTVboost-SIB剂量均匀性更好(0.06±0.01 vs 0.09±0.02,t=-4.522,P<0.001)。与VMAT-SEB相比,VMAT-SIB中PTVboost,PTV及PTV-PTVboost的靶区适形度更优(1.01±0.02 vs 1.03±0.02,t=-2.240,P=0.036;1.00±0.01vs 1.03±0.02,t=-3.260,P=0.004;1.00±0.02 vs 1.03±0.03,t=-3.212,P=0.004)。TOMO-SIB的同侧肺D_(mean)、V5及V_(20)均显著性低于VMAT-SIB[(7.36±1.27)Gy vs(9.49±1.97)Gy,t=-2.872,P=0.011;28.22%±3.56%vs 37.68%±8.07%,t=-3.477,P=0.003;14.33%±4.20%vs 19.75%±4.60%,t=-2.670,P=0.016],TOMO-SEB的同侧肺D_(mean)V_(20)显著性低于VMAT-SEB[(7.90±1.79)Gy vs(9.38±1.49)Gy,t=-2.212,P=0.037;13.89%±3.76%vs 17.97%±3.55%,t=-2.703,P=0.013]。对于健侧乳腺,VMAT-SIB的D_(mean)显著性低于TOMO-SIB[(3.99±1.35)Gy vs(2.25±1.79)Gy,t=2.424,P=0.027],VMAT-SEB的D_(mean)及V_(20)显著性低于TOMO-SEB[(4.69±1.78)Gy vs(2.28±1.86)Gy,t=3.150,P=0.004;5.10%±5.80%vs 2.24%±3.50%,t=1.549,[Objective]To compare the dosimetric parameters of simultaneous integrated boost(SIB)and sequential boost(SEB)in hypofractionated radiotherapy after breast-conserving surgery for early-stage breast cancer.[Methods]A total of 44 early-stage breast cancer patients after breast-conserving surgery who underwent volumetric modulated arc therapy(VMAT)or Tomo therapy(TOMO)in Jilin Cancer Hospital from October 2021 to August 2023 were enrolled in the study.Among them,19 cases received SIB(TOMO 11,VMAT 8)and 25 cases received SEB(TOMO 9,VMAT 16).The prescription dose for planning target volume boost(PTVboost)in SIB plan was 48.0 Gy,3.2 Gy/15 f,and for planning target volume PTV)was 40.05 Gy,2.67 Gy/15 f.The prescription dose for PTVboost in SEB plan was 52.2 Gy,2.9 Gy/18 f,and for PTV was 43.5 Gy,2.9 Gy/15 f.[Results]Compared,with TOMO-SEB,the V_(107)of PTV and PTV-PTVboost in TOMO-SIB were significantly lower(38.89%±10.58%vs 59.87%±21.49%,t=-2.854,P=0.011;32.90%±12.35%vs 52.22%±17.89%,t=-2.852,P=0.011),and the dose homogeneity of PTVboost-SIB was better(0.06±0.01 vs 0.09±0.02,t=-4.522,P<0.001).Compared with VMAT-SEB,PTVboost,PTV and PTV-PTVboost in VMAT-SIB had better target conformity(1.01±0.02 vs 1.03±0.02,t=-2.240,P=0.036;1.00±0.01 vs 1.03±0.02,t=-3.260,P=0.004:1.00±0.02 vs 1.03±0.03,t=-3.212,P=0.004).The D_(mean),V_5,and V_(20)of the ipsilateral lung in TOMO-SIB were significantly lower than those in VMAT-SIB[(7.36±1.27)Gy vs(9.49±1.97)Gy,t=-2.872,P=0.011;28.22%±3.56%vs 37.68%±8.07%,t=-3.477,P=0.003;14.33%±4.20%vs 19.75%±4.60%,t=-2.670,P=0.016],and the D_(mean)and V_(20)of the ipsilateral lung in TOMO-SEB were significantly lower than those in VMAT-SEB[(7.90±1.79)Gy vs(9.38±1.49)Gy,t=-2.212,P=0.037;13.89%±3.76%vs 17.97%±3.55%,t=-2.703,P=0.013].For the contralateral breast,the D_(mean)of VMAT-SIB was significantly lower than that of TOMO-SIB[(3.99±1.35)Gy vs(2.25±1.79)Gy,t=2.424,P=0.027],and the D_(mean)and V_(20)of VMAT-SEB were significantly lower than those of TOMO-SEB[(4.69±1.78)Gy vs(2.28

关 键 词：乳腺癌 大分割放疗 瘤床加量 剂量学 

分 类 号：R737.9[医药卫生—肿瘤]