摘要
探讨调强放疗(Intensity-modulated radiotherapy,IMRT)在早期乳腺癌放疗中的剂量学优势,以期得到有价值的循证医学证据以指导临床应用。使用计算机检索Pub Med、EMbase、Sciencedirect、中国知网、维普、万方数据库,同时辅助其它检索,收集关于早期乳腺癌保乳术后三维适形技术(Three-dimensional conformal radiotherapy,3D-CRT)与IMRT剂量学比较的文献,应用Rev Man 5.2.0软件对满足条件的15项(263例患者)数据进行Meta分析。结果表明,与3D-CRT相比,IMRT显著降低了患侧肺V20(p=0.004)、V30(p=0.008)、V40(p=0.000 8)、Dmax(p=0.001)和心脏V30(p=0.002)、V40(p=0.000 01);降低了计划靶区Dmax(p<0.000 01);对V95(p=0.05)、V105(p<0.000 1)、V110(p<0.000 01)覆盖更好;均匀指数HI及适形指数CI也较好,p=0.02;但却增加了患侧肺V5(p=0.000 5)、V10(p=0.05),心脏V5(p<0.000 1)、V10(p=0.000 7),健侧肺V5(p=0.002)、Dmen(p=0.000 4)和健侧乳腺V3(p=0.000 6)。计划靶区V100、Dmean、Dmin、患侧肺Dmean、心脏V20、Dmax、Dmean、健侧乳腺Dmean,IMRT与3D-CRT相似,差异不显著。结果提示,在早期乳腺癌保乳术后放疗中,IMRT对靶区覆盖好且剂量分布均匀,并可以减少高剂量照射区正常组织的剂量,保护正常组织,但却增加了低剂量照射区组织的剂量。
The aim was to evaluate the dosimetry superiority of IMRT （Intensity-modulated radiotherapy） in early-stage breast cancer with conserving surgery and provide more valuable evidences to the clinical researches. Clinical trials of dosimetric comparision between 3D-CRT and IMRT for early-stage breast cancer with conserving surgery were obtained from PubMed, EMbase, Sciencedirect, Wei pu, CNKI （China national knowledge Infrastructure）, and Wanfang databases, which were evaluated and analyzed with the Cochrane Collaboration＇s RevMan 5.2.0 software. Fifteen samples were included. Compared with 3D-CRT plans, IMRT plans had a lower ipsilateral lung V20（p=0.004）, V30 （p=0.008）, V40（p=0.0008）, Dmax（p=0.001） and heart V30 （p=0.002）, V40（p〈0.00001）, while had a higher ipsilateral lung V5 （p=0.000 5）, V10 （p=0.05） and heart V5 （p〈0.000 1）, Vlo （p=0.000 7）. IMRT plans provided a significantly better coverage of the PTV Vgs （p=0.05）, V105 （p〈0.000 1）, V110 （p〈0.000 01） and maximal dose （p〈0.000 01）. IMRT plans had a better dose homogeneity index and conformity index than 3D-CRT plans, both with p=0.02, but had a higher contralateral lung V5 （p=0.002）, Dmax （p=0.000 4） and eontralateral breast V3 （p=0.000 6） There was no significant difference between IMRT and 3D-CRT plans for V100, mean and minimal doses of PTV, ipsilateral lung mean dose, heart V20, maximum, mean dose, and contralateral mean dose, all p〉0.05. Compared with 3D-CRT plans, IMRT plans had the dosimetry superiority for early-stage breast cancer with significantly better coverage and dose homogeneity of planning target volume while maintaining lower doses to high risk organs.
出处
《辐射研究与辐射工艺学报》
CAS
CSCD
2016年第3期17-23,共7页
Journal of Radiation Research and Radiation Processing
基金
辽宁省医院改革重点临床科室诊疗能力建设项目(NCCC-B08-2014)资助~~
关键词
早期乳腺癌
放射治疗
三维适形放射治疗
调强放射治疗
META分析
Breast cancer, Radiotherapy, Three-dimensional conformal radiotherapy （3D-CRT）, Intensitymodulated radiotherapy （IMRT）, Mcta-analysis
