摘要
目的:探究特定密度的3D打印补偿膜在乳腺癌放疗中的临床应用,并评估其对剂量分布和放疗摆位的影响。方法:随机选取行调强放疗的乳腺癌切除术后患者40例,使用3D打印补偿膜与常规补偿膜各20例,均采用发泡胶仰卧位固定。基于室内激光和体表标记进行常规摆位,每日Catalyst HD光学体表引导结合每周一次CBCT验证。记录不同补偿膜下的绝对剂量、患者皮肤表面剂量、手术切口、计划布野、靶区剂量(V_(CTV 50 Gy)、V_(PTV 50 Gy))和危及器官受量,并计算适形度指数和均匀性指数;同时,记录患者的CBCT及Catalyst HD摆位误差。结果:不同补偿膜下的绝对剂量差异无统计学意义(P>0.05),3D打印补偿下的皮肤表面剂量显著高于常规补偿(P<0.05),二者分别为(54.83±0.44)Gy和(54.43±0.51)Gy。使用3D打印补偿膜的患者较常规补偿膜的适形度指数更高,二者分别为0.69±0.04和0.65±0.02。基于不同补偿膜,V_(CTV 50 Gy)差异无统计学意义(P>0.05),3D打印补偿膜的患者V_(PTV 50 Gy)略低于常规补偿膜,且危及器官受量更低(P<0.05),心脏Vmean分别为9.68%±3.24%和11.43%±3.60%。3D打印补偿膜的患者中,计划布野及手术切口对靶区剂量均存在影响,不包内乳的靶区剂量较包内乳更大(P<0.05)。当布野不包内乳时,不同手术切口仅对V_(PTV 50 Gy)存在影响,且横梭形较斜竖形切口的V_(PTV 50 Gy)更高(P<0.05),二者分别为95.58%±0.51%和95.44%±0.71%。3D打印与常规补偿膜的光学监测误差仅在左右方向存在差异,分别为(0.08±0.57)cm和(-0.15±0.46)cm(P<0.05)。结论:与常规补偿膜相比,3D打印补偿膜可提高剂量分布和光学监测误差;同时3D打印补偿膜下的手术切口和计划布野对靶区剂量均存在一定影响。
Objective To investigate the clinical application of 3D printed bolus with specific density in breast cancer radiotherapy,and to evaluate its effects on dose distribution and positioning.Methods Forty post-mastectomy patients undergoing intensitymodulated radiotherapy were randomly enrolled for 3D printed bolus(n=20)and conventional bolus(n=20),and all patients were fixed in the supine position using styrofoam.Conventional positioning was performed based on in-room lasers and body markers,with daily Catalyst HD optical surface monitoring combined with weekly CBCT verification.The absolute dose,patients'skin surface dose,surgical incision,planned field,target area doses(V_(CTV 50 Gy),V_(PTV 50 Gy))and organs-at-risk doses in patients with different boluses were recorded,and the conformity index and homogeneity index were calculated,and the setup errors using CBCT and Catalyst HD were also analyzed.Results The difference in absolute dose between different boluses was trivial,but the skin surface dose with 3D printed bolus was significantly higher than with conventional bolus[(54.83±0.44)Gy vs(54.43±0.51)Gy,P<0.05].Patients with 3D printed boluses had a higher conformity index than with conventional boluses(0.69±0.04 vs 0.65±0.02).For different boluses,there was no significant difference in V_(CTV 50 Gy),while the V_(PTV 50 Gy)and organs-at-risk doses were lower in those with 3D printed bolus than conventional boluses(P<0.05),with heart Vmean of 9.68%±3.24%vs 11.43%±3.60%.In patients with 3D printed boluses,both planned field arrangement and surgical incision affected the target doses,and the doses of the target area without an internal breast wrap was greater than those with internal breast wrap(P<0.05).When the field was not wrapped around the internal breast,the surgical incisions only affected VPTV50 Gy,and the VPTV50 Gy was greater with the transverse fusiform incision than with the oblique vertical incision(P<0.05),which were 95.58%±0.51%vs 95.44%±0.71%.The optical monitoring accuracies with different
作者
雷金艳
曹潘潘
张倩
李建锋
代馨瑶
王雪纯
靳富
彭海燕
LEI Jinyan;CAO Panpan;ZHANG Qian;LI Jianfeng;DAI Xinyao;WANG Xuechun;JIN Fu;PENG Haiyan(Radiation Physics Center,Chongqing University Cancer Hospital,Chongqing 400030,China)
出处
《中国医学物理学杂志》
CSCD
2024年第6期683-689,共7页
Chinese Journal of Medical Physics
基金
重庆市科卫联合医学科研项目(2022DBXM005)
重庆市沙坪坝区技术创新与应用发展项目(2023129)
重庆市教育委员会科学技术研究项目(KJQN202300126)。
