乳腺癌内乳淋巴结转移患者术后VMAT与IMRT的剂量学、急性放射不良反应比较  

Surgical Management and Comparison of Lymph Node VMAT and IMRT in Patients with Internal Mammary-lymph Node Metastasis in Breast Cancer

作　　者：柳元 苏传付 LIU Yuan;SU Chuanfu(Linyi Cancer Hospital,Linyi,276000)

机构地区：[1]山东省临沂市肿瘤医院,276000

出　　处：《实用癌症杂志》2025年第2期261-265,共5页The Practical Journal of Cancer

摘　　要：目的比较乳腺癌内乳淋巴结转移患者胸腔镜内乳淋巴结清扫术后体积调制电弧治疗(VMAT)与调强放射治疗(IMRT)的周围危及器官(OARs)的剂量学和急性放射不良反应。方法选取126例内乳淋巴结转移的乳腺癌患者,均行常规乳腺癌根治术+胸腔镜内乳淋巴结清扫术,术后根据放疗计划方案分为VMAT组(65例)和IMRT(61例)组,比较2组患者术后OARs放射剂量学及急性放射不良反应。结果2组临床疗效无统计学差异(P>0.05)。VMAT组患者的心脏V30、V40、Dmean明显低于IMRT组(P<0.05);VMAT组患者的患侧肺V20、V5和健侧肺V5明显低于IMRT组(P<0.05);VMAT组患者的CI、HI明显低于IMRT组(P<0.05);VMAT组患者的乳腺Dmax、Dmean和脊髓Dmean明显低于IMRT组(P<0.05)。VMAT组的急性放射性食管炎和肺炎明显少于IMRT组(P<0.05)。结论乳腺癌内乳淋巴结转移患者采用胸腔镜内乳淋巴结清扫术能清除部分内乳转移淋巴结,术后给予VMAT能降低对OARs的放射剂量并减少急性放射不良反应发生。Objective To explore the surgical management of thoracoscopic breast lymph node dissection in breast cancer patients with breast lymph node metastasis,and Comparison of dosimetry and acute radiation toxicity between 2 different postoperative post-peripheral radiation therapy(VMAT)and intensity-modulated radiation therapy(IMRT).Methods 126 cases of breast cancer patients with internal mammary lymph node metastasis were selected and all underwent conventional radical mastectomy plus thoracoscopic internal mammary lymph node dissection.They were divided into VMAT group(65 cases)and IMRT group(61 cases)according to different radiotherapy plans after operation.The postoperative oars dosimetry and acute radiation toxicity of the two groups were compared.Results There was no statistical difference in the clinical efficacy between the 2 groups(P>0.05);V30,V40,and Dmean were significantly lower in VMAT than IMRT(P<0.05);V20 and V5 of the affected lung and V5 of the healthy lung in VMAT were significantly lower than IMRT(P<0.05);CI and HI in VMAT were significantly lower than IMRT(P<0.05);breast Dmax,Dmean,and spinal Dmean in VMAT were significantly lower than IMRT(P<0.05);acute radiation esophagitis and pneumonia in VMAT were significantly lower than IMRT(P<0.05).Conclusion The patients with breast cancer internal mammary lymph node metastasis can remove some internal mammary lymph nodes after endoscopic breast lymph node dissection,VMAT can reduce the radiation dose to OARs and reduce the occurrence of acute radiation toxicity.

关 键 词：乳腺癌内乳淋巴结转移 手术 VMAT IMRT 剂量学 放射毒性 

分 类 号：R737.9[医药卫生—肿瘤]