2种容积旋转调强技术在乳腺癌改良根治术后放疗剂量学中的应用比较

Dosimetric comparison between two volumetric modulated photon arc therapies for patients with breast cancer mastecomy

  • 摘要: 目的:探讨双弧容积旋转调强(DA-VMAT)相比多个部分弧形容积旋转调强(MP-VMAT)在乳腺癌改良根治术后放疗中的剂量学特点及治疗效率。方法2012年8月-2013年8月江苏省人民医院放射治疗科收治的乳腺癌改良根治术后患者19例,采用相同剂量学限制条件分别制订 DA-VMAT 及 MP-VMAT 计划,通过其剂量学对比分析评估靶区和危及器官,同时比较2种方法的治疗时间及治疗跳数。结果 MP-VMAT 计划靶区适形度指数和均匀性指数优于 DA-VMAT,分别为0.56和1.06及0.36和1.14(P <0.05)。MP-VMAT降低对侧肺V205.53%,同侧肺的Dmean、V5和V20分别为3.74 Gy、6.27%和5.53%;MP-VMAT 降低心脏 V5和 V10分别为10.33%和7.82%;MP-VMAT 降低对侧乳腺的 V5、V10和 V15分别为9.14%、2.72%和0.06%,但 MP-VMAT 计划的机器治疗跳数745.9 MU 明显高于 DA-VMAT 524.4 MU,治疗时间304.6 s 明显长于 DA-VMAT 196.7 s(P <0.05)。结论 MP-VMAT 计划较 DA-VMAT 有更优的靶区剂量分布,并降低了大部分危及器官的照射剂量,但 MP-VMAT 延长了治疗时间,并增加了机器跳数,临床实践中应根据患者的具体病情采用不同的放疗技术。

     

    Abstract: Objective To compare the dosimetry and treatment efficiency between a multi-ple partial volumetric-modulated arcs therapy (MP-VMAT)and double-arc volumetric modulated arc therapy (DA-VMAT)for patients with breast cancer mastecomy.Methods 19 patients with breast cancer treated by mastecomy and requiring postoperative radiotherapy were collected.MP-VMAT and DA-VMAT plans were applied for each patient respectively.Dosimetry parameters for target volume and organ of risks (OARs)were compared.Machine unite and delivery times were compared.Results MP-VMAT plans had a more uniform target dose distribution with average Conformation Index (CI )andHomogeneity Index (HI )of0 .5 6 and 1 .0 6 compared to 1 .0 6 and 1.14 of the DA-VMAT plans(P <0.05).MP-VMAT plans predicted a reduction of 5.53% in V20 of contralateral lung,3.74 Gy in mean dose,6.27% in V5 and 5.53% in V20 of ispleratal lung respectively (P <0.05).MP-VMAT plans predicted a reduction of 10.33% and 7.82% in V5 and V10 of heartrespectively (P <0.05),MP-VMAT plans predicted a reduction of 9.14%, 2.72% and 0.06% inV5,V10 and V15 of contralateral breast respectively (P <0.05)plans. However,MP-VMAT plans improved monitor units 7 4 5 .9 MU and treatment time 3 0 4 .6 s compared with DA-VMAT 524.4 MU and 196.7 s (P <0.05).Conclusion MP-VMAT plans generate more uniformity in the target dose and decreased the dose of most of organs of risk com-pared to the DA-VMAT,But improved monitor units and treatment time.In clinical application, different techniqies are chosen based on the situation of every patient.

     

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