不同放射治疗技术在左侧乳腺癌保乳术后全乳腺照射中的剂量学比较  

Dosimetric comparison of different radiotherapy techniques in whole breast irradiation after breast-conserving surgery for left breast cancer

作　　者：宁静 赵志鹏[1] 郭昕 武宁[1] NING Jing;ZHAO Zhipeng;GUO Xin;WU Ning(Department of Radiation Oncology,China-Japan Union Hospital of Jilin University,Jilin Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院放射治疗科,吉林长春130033

出　　处：《现代肿瘤医学》2025年第4期598-606,共9页Journal of Modern Oncology

基　　金：国家自然科学基金项目(编号:81201737);吉林省科技发展计划资助项目(编号:20200201524JC);吉林省教育厅科学技术研究项目(编号:JJKH20211196KJ);吉林省财政厅卫生科研人才专项项目(编号:2024SCZ66);吉林大学技术开发(委托)项目(编号:2023220103000073)。

摘　　要：目的:通过比较4种放射治疗技术在左侧乳腺癌保乳术后全乳腺照射中的剂量学差异,分析各技术的临床应用优势。方法:选取20例左侧乳腺癌保乳术后患者,分别进行调强放射治疗、容积弧形放疗、螺旋断层放疗和固定野断层放疗技术的模拟计划设计。分析评价4种放射治疗技术设计的计划中靶区和危及器官的剂量学参数差异。结果:4种放射治疗技术设计的计划均能满足左侧乳腺癌保乳术后全乳腺照射的临床要求。其中螺旋断层放疗技术的靶区均匀性优于其他技术,而容积弧形放疗技术则具有更好的靶区适形度(P<0.05)。与其他放疗技术相比,螺旋断层放疗技术明显降低了心脏(D_(max)、V_(30)和V_(20))、冠脉左前降支(D_(mean)、D_(max)、D_(2%)、V_(30)、V_(10)和V_(5))和患侧肺(V_(40)和V_(20))的受照剂量(P=0.00),而容积弧形放疗技术对照射野内皮肤(D_(10cc)、V_(50)、V_(40)、V_(30)、D5%和D_(2%))的保护更为显著(P<0.05)。结论:对于左侧乳腺癌保乳术后全乳腺照射,螺旋断层放疗技术设计的计划具有一定的相对优势。放射治疗计划设计应综合权衡靶区和危及器官的剂量学获益,个体化选择合适的放疗技术。Objective:To compare the dosimetric differences of the four techniques in whole breast irradiation after breast-conserving surgery for left breast cancer,and to analyze the clinical application advantages of each technique.Methods:20 patients with left breast cancer after breast-conserving surgery were selected for the design of simulation plans for intensity modulated radiation therapy,volumetric modulated arc therapy,helical tomotherapy and direct tomotherapy.The differences in dosimetry parameters of the planning target volume and organs at risk by the four radiotherapy technological plans were analyzed and evaluated.Results:The four radiotherapy techniques can meet the clinical requirements of whole breast irradiation after breast-conserving surgery for left breast cancer.Among them,the target uniformity of helical tomotherapy technique was better than other technologies.While the volumetric modulated arc therapy had better target conformability(P<0.05).Compared with other radiotherapy techniques,helical tomotherapy technique significantly decreased the exposure dose of the heart(D_(max),V_(30)and V_(20)),left anterior descending coronary arterie(D_(mean),D_(max),D_(2%),V_(30),V_(10)and V_(5))and the ipsilateral lung(V_(40)and V_(20))(P=0.00).Moreover,volumetric modulated arc therapy technique has the protection effect for the skin within the irradiation field(D_(10cc),V_(50),V_(40),V_(30),D 5%,and D_(2%))(P<0.05).Conclusion:For the whole breast irradiation after breast-conserving surgery for left breast cancer,the plan designed by helical tomotherapy technology has certain comparative advantages.The design of radiotherapy plan should comprehensively weigh the dosimetric benefits of the target area and organs at risk,and individualized selection of appropriate radiation therapy techniques.

关 键 词：放射治疗 乳腺癌 剂量学 

分 类 号：R737.9[医药卫生—肿瘤]