VMAT与TOMO治疗双侧乳腺癌的剂量学差异研究  

Dosimetric Comparison of VMAT and TOMO in the Treatment of Bilateral Breast Cancer

作　　者：王自路 王相[1] 曹红诗[1] 张永春[1] 姜鹏[1] Wang Zilu;Wang Xiang;Cao Hongshi;Zhang Yongchun;Jiang Peng(Radiation Therapy Center,the Affliated Hospital of Qingdao University,Qingdao 266000,Shandong,China)

机构地区：[1]青岛大学附属医院放疗技术中心,山东青岛266000

出　　处：《肿瘤预防与治疗》2025年第3期216-223,共8页Journal of Cancer Control And Treatment

基　　金：吴阶平医学基金会临床科研专项资助基金(编号:320.6750.2022-9-22)。

摘　　要：目的:比较分析双侧乳腺癌术后采用容积旋转调强放射治疗(volumetric modulated arc therapy,VMAT)和螺旋断层放射治疗(helical tomotherapy,TOMO)两种放疗技术的靶区和危及器官的剂量学差异,研究各自具备的临床优势。方法:选择10例双侧乳腺癌术后放疗患者,靶区和危及器官(organs at risk,OARs)的轮廓勾画一致,设计VMAT和TOMO两组计划,对其剂量学参数进行分析。结果:靶区剂量分布方面,适形度指数(conformity index,CI)和剂量梯度指数(gradient index,GI)TOMO组均优于VMAT组,但CI的差异无统计学意义(P>0.05),GI的差异有统计学意义(P<0.05)。均匀性指数两者表现一致;OARs保护方面,相较于VMAT组,TOMO组计划脊髓最大点剂量受量明显降低,且双肺和肝脏的受照体积和平均受量(D_(mean))显著减少,差异均有统计学意义(P<0.05)。关于心脏的受量,TOMO组D_(mean)低于VMAT组,V_(5)、V_(10)的受量低于VMAT组,但V_(20)和V_(30)的受量要高于VMAT组,其中D_(mean)、V_(5)的差异均有统计学意义(P<0.05),V_(10)、V_(20)、V_(30)的差异无统计学意义(P>0.05);治疗时间方面,VMAT组比TOMO组治疗时间更短,且差异有统计学意义(P<0.01)。结论:针对双侧乳腺癌的两种调强放射治疗技术比较,TOMO和VMAT在靶区的剂量分布方面拥有同样优异的适形度和均匀度,TOMO的优势表现在于剂量梯度跌落更迅速,对降低肺、心脏、肝脏、脊髓受量,保护正常组织能起更好的效果,VMAT的优势表现在于拥有更短的治疗时间,治疗效率较高。Objective:To comparatively analyze the dosimetric differences in target volumes and organs-at-risk following bilateral breast cancer surgery using volumetric modulated arc therapy(VMAT)and helical tomotherapy(TOMO),and to investigate their respective clinical advantages.Methods:Ten patients who underwent bilateral mastectomy for breast cancer were selected,with consistent contours of target volumes and organs at risk.Treatment plans using VMAT and TOMO were designed,and their dosimetric parameters were analyzed.Results:In terms of target dose distribution,the conformity index in the TOMO group was superior to that in the VMAT group(P>0.05),while the gradient index in the TOMO group was significantly superior to that in the VMAT group(P<0.05).The homogeneity index was consistent between the two groups.In terms of organs at risk protection,the maximum dose to the spinal cord in the TOMO group was significantly lower than that in the VMAT group.Additionally,the irradiated volume and mean dose(D_(mean))to both the lungs and liver were significantly lower in the TOMO group compared to the VMAT group.The differences were all statistically significant(P<0.05).Regarding the dose to the heart,the TOMO group exhibited a lower D_(mean)compared to the VMAT group,and the doses of V_(5)and V_(10)were also lower than those in the VMAT group.However,the doses of V_(20)and V_(30)were higher than those in the VMAT group.Differences in D_(mean)and V_(5)were statistically significant(P<0.05),while the differences in V_(10),V_(20)and V_(30)were not statistically significant(P>0.05).The treatment time in the VMAT group was significantly shorter than that in the TOMO group(P<0.01).Conclusion:In the comparison of two intensity-modulated radiation therapy techniques for bilateral breast cancer,TOMO and VMAT demonstrate equally excellent conformity and homogeneity in dose distribution to the target volume.The advantage of TOMO lies in its steeper dose gradient fall-off,which provides better protection for normal tissues by reducing the do

关 键 词：螺旋断层放射治疗 剂量学 双侧乳腺癌 容积旋转调强放射治疗 铅门跟随 动态铅门 

分 类 号：R730.55[医药卫生—肿瘤] R737.9[医药卫生—临床医学]