摘要
目的:探究左侧乳腺癌保乳术后基于内缘切线拉弧的容积调强放疗(volumetric modulated arc therapy,VMAT)与常规切线拉弧的VMAT的剂量学差异,挖掘VMAT技术在乳腺癌保乳术后更大的获益,为乳腺癌保乳术后VMAT计划设计提供更多的参考和数据支持。方法:回顾性选取30例左侧乳腺癌保乳术后行调强放疗的患者,为每位患者分别设计常规切线拉弧(conventional tangential arc,CTA)和内缘切线拉弧(inner edge tangentialarc,IETA)两组VMAT计划。统计两组计划的靶区适形度指数(conformity index,CI)、均匀性指数(homogeneity index,HI)、机器跳数、危及器官受照剂量等数据,并进行数据分析。结果:靶区适形性指数(CI)CTA组和IETA组分别为0.86±0.02和0.87±0.02(P<0.05),D_(98)、D_(50)、D_(2)、均匀性指数(HI)和机器跳数均无明显差异(P>0.05);IETA组危及器官左肺V_(5)、V_(10)、V_(20)、V_(30)、V_(40)、D_(mean),右肺V_(5)、D_(mean),心脏V_(5)、V_(10)、V_(20)、D_(mean)均低于CTA组(P<0.05),其中左肺V_(5)和V_(20)CTA组和IETA组分别为37.18±7.18 vs 34.32±6.43、11.00±2.40 vs 9.65±2.17;右肺D_(mean)和心脏D_(mean)CTA组和IETA组分别为302.26±42.78 vs 273.50±26.62,479.30±60.08 vs 442.39±140.92,IETA组均低于CTA组;两组右侧乳腺D_(mean)相差甚微(P>0.05)。结论:两种计划均能满足临床要求,但IETA的VMAT靶区适形度明显提高,同时还显著降低了左肺、右肺、心脏和脊髓的受量。因此,左侧乳腺癌保乳术后基于内缘切线拉弧VMAT可实现靶区和危及器官更大的获益,值得推荐。
Objective:To investigate the dosimetric difference between VMAT based on inneredge tangential arc and conventional tangential arc after breast-conserving surgery for left breast cancer,explore the greater benefit of VMAT technique after breast-conserving surgery for breast cancer,and provide more references and data support for the design of VMAT plan after breast-conserving surgery for breast cancer.Methods:30 patients with left breast cancer who received intensity-modulated radiotherapy after left breast-conserving surgery were selected,the conventional tangential arc(CTA)and inner edge tangential arc(IETA)VMAT plans were designed for each.Data such as conformity index(CI),homogeneity index(HI),the number of machine unit and dose of endangered organs of the two groups of plans were collected and analyzed.Results:The target area conformity index(CI)was 0.86±0.02(CTA group)and 0.87±0.02(IETA group),the difference was statistically significant(P<0.05),and there were no significant differences in D_(98),D_(50),D_(2),homogeneity index(HI),and the number of machine unit(P>0.05).The V_(5),V_(10),V_(20),V_(30),V_(40),and D_(mean) of left lung,V_(5),D_(mean) of right lung,and V_(5),V_(10),V_(20),D_(mean) of heart in IETA group were lower than those in the CTA group,the difference was statistically significant(P<0.05).The V_(5),V_(20) of left lung in CTA group and IETA group were 37.18±7.18 vs 34.32±6.43,11.00±2.40 vs 9.65±2.17.The D_(mean) of right lung and heart in CTA group and IETA group were 302.26±42.78 vs 273.50±26.62,479.30±60.08 vs 442.39±140.92,these parameters of the IETA group were lower than that of the CTA group.There was little difference in the D_(mean) of right breast between the two groups(P>0.05).Conclusion:Both plans satisfied the clinical requirements,IETA group can not only improve CI,but also significantly reduce the dose of left lung,right lung,heart and spinal cord.Therefore,it is recommended to use the inner edge tangential arc of VMAT after left breast cancer-conserving surgery to obt
作者
蒲琴
赵彪
袁美芳
林玲
李静
杨毅
PU Qin;ZHAO Biao;YUAN Meifang;LIN Ling;LI Jing;YANG Yi(Department of Radiation Oncology,Peking University Cancer Hospital Yunnan,The Third Affiliated Hospital of Kunming Medical University,Yunnan Cancer Hospital,Yunnan Kunming 650118,China)
出处
《现代肿瘤医学》
CAS
2024年第8期1480-1485,共6页
Journal of Modern Oncology
基金
国家自然科学基金资助项目(编号:81760423)
云南省卫生科技计划项目(编号:2017NS192)。
关键词
内缘切线
VMAT
左侧乳腺癌
保乳术后
剂量学
inner edge tangential arc
VMAT
left breast cancer
breast-conserving surgery
dosimetry
