放疗技术对乳腺癌改良根治术后大分割调强放射治疗计划影响

王宁; 徐航; 苏洪新; 祁宁; 张珠祥; 冉俊涛

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放疗技术对乳腺癌改良根治术后大分割调强放射治疗计划影响

临床医学研究 | 更新时间：2023-04-14

- 放疗技术对乳腺癌改良根治术后大分割调强放射治疗计划影响
- Influence of radiotherapy technology on the planning of hypofractionated intensity-modulated radiotherapy after modified radical mastectomy for breast cancer
- 西南医科大学学报 2021年44卷第1期页码：41-45
- 作者机构：
  
  兰州大学第一医院放疗科
- 作者简介：
- 基金信息：
  
  甘肃省卫生行业科研管理项目（2019-19）
- DOI：
  中图分类号： R737.9
- 纸质出版日期：2021，
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[1]王宁,徐航,苏洪新,祁宁,张珠祥,冉俊涛.放疗技术对乳腺癌改良根治术后大分割调强放射治疗计划影响[J].西南医科大学学报,2021,44(01):41-45.

WANG Ning, XU Hang, SU Hongxin, et al. Influence of radiotherapy technology on the planning of hypofractionated intensity-modulated radiotherapy after modified radical mastectomy for breast cancer[J]. Journal of Southwest Medical University, 2021,44(1):41-45.
[1]王宁,徐航,苏洪新,祁宁,张珠祥,冉俊涛.放疗技术对乳腺癌改良根治术后大分割调强放射治疗计划影响[J].西南医科大学学报,2021,44(01):41-45. DOI：

WANG Ning, XU Hang, SU Hongxin, et al. Influence of radiotherapy technology on the planning of hypofractionated intensity-modulated radiotherapy after modified radical mastectomy for breast cancer[J]. Journal of Southwest Medical University, 2021,44(1):41-45. DOI：

摘要

目的:乳腺癌改良根治术术后大分割放疗是推荐剂量分割方案之一

本文通过比较三种不同大分割调强放疗（intensity-modulated radiotherapy

IMRT）技术在肿瘤靶区和正常组织的剂量学差异

为临床放疗计划设计提供依据。方法:22例乳腺癌改良根治术后患者均接受CT定位

参考美国肿瘤放射治疗协作组（radiotherapy oncology group

RTOG）

乳腺癌改良根治术后靶区勾画建议在CT模拟图像上勾画靶区

同时定义心脏（包括左右心室、心房）、同侧与对侧肺、对侧乳腺为危及器官。每例患者均利用调强放射治疗计划系统进行部分铅门固定动态技术调强技术

铅门完全跟随技术动态调强技术

以及铅门完全跟随静态调强技术进行计划设计

胸壁及锁骨上下区处方剂量均为40.05 Gy/15次。采用DVH和机器跳数等相关参数比较三种计划的剂量学差异。结果:三种技术获得的调强计划均能满足临床要求

分别进行配对比较

计划靶区的评估参数D50、D98差异均无统计学意义

计划组P-fixed-D（部分铅门固定动态技术调强）

P-unfixed-D（铅门完全跟随技术动态调强）以及P-unfixed-S（铅门完全跟随静态调强）跳数总体呈降低趋势

分组相比

差异均具有统计学意义（P <0.05）

P-fixed-D计划组均匀性指数（CI）较高。就危及器官而言

分组相比

心脏V30、脊髓Dmax差异均无统计学意义（P> 0.05）

计划组P-fixed-D相较于其他两组

患侧肺V5

心脏平均剂量Dmean

健侧乳腺Dmean都有所降低

差异均具有统计学意义（P <0.05）。结论:部分铅门固定动态调强技术降低了危及器官受照剂量并将靶区的适形指数和均匀性维持在合理可接受的范围内

推荐用于乳腺癌改良根治术后大分割放疗计划设计。

Abstract

Objective:To investigate the dosimetric difference between three hypofractionated intensity-modulated radiotherapy（IMRT） techniques in tumor target volume and normal tissue

since hypofractionated radiotherapy is one of the recommended regimens after modified radical mastectomy for breast cancer

and to provide a basis for the planning and design of clinical radiotherapy. Methods:A total of 22 patients after modified radical mastectomy for breast cancer received CT simulation

and the target volume was delineated on CT simulation images with reference to the RTOG suggestion for target volume delineation after modified radical mastectomy for breast cancer. The heart（left and right ventricles and atria）

the ipsilateral and contralateral lungs

and the contralateral breast were defined as organs at risk. The IMRT planning system was used for each patient to plan and design partly fixed-jaw dynamic IMRT

jaw-tracking dynamic IMRT

and jaw-tracking static IMRT

and the prescribed dose was 40.05 Gy/15 fractions for the chest wall and the supraclavicular and infraclavicular regions. Dose-volume histogram and number of monitor units were used to compare the dosimetric difference between the three plans. Results:The IMRT plans obtained by the three techniques met clinical requirements. Pairwise comparison showed that there were no significant differences in the evaluation parameters D50 and D98 of planning target volume. The P-fixed-D group（partly fixed-jaw dynamic IMRT） had the highest number of monitor units

followed by the P-unfixed-D group（jaw-tracking dynamic IMRT） and the P-unfixed-S group（jaw-tracking static IMRT）

and there was a significant difference between groups（P < 0.05）. The P-fixed-D group had the highest conformity index. For the organs at risk

there were no significant differences in V30 of the heart and Dmaxof the spinal cord between groups（P > 0.05）

and compared with the other two groups

the P-fixed-D group had significant reductions in V5 of the ipsilateral lung

Dmeanof the heart

and Dmeanof the contralateral breast（P < 0.05）. Conclusion:Partly fixed-jaw dynamic IMRT reduces the exposure dose to organs at risk and maintain conformity index and homogeneity index of planning target volume within a reasonable and acceptable range

and therefore

it is recommended to be used in the planning and design of hypofractionated IMRT after modified radical mastectomy for breast cancer.

关键词

固定铅门技术（FJT）铅门跟随技术（JTT）放射治疗计划静态调强（SIMRT）动态调强（DIMRT）

Keywords

Fixed-jaw techniqueJaw-tracking techniqueRadiotherapy planningStatic intensity-modulated radiation therapyDynamic intensity-modulated radiation therapy

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