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左乳癌保乳术后瘤床同步推量断层螺旋照射与断层定角照射的放疗剂量学研究

Study on dosimetry of radiotherapy between TomoHelical and TomoDirect with simultaneous integrated boost for tumor bed after breast-conserving surgery of left breast cancer

    摘要
  • 摘要:
      目的  探讨左乳癌保乳术后银夹标记瘤床同步推量断层螺旋照射(TH)与断层定角照射(TD)的剂量学特点。
      方法  选取左乳癌保乳术后患者20例, 采用TOMO治疗计划系统设计TH和TD计划, 分析两种计划的剂量学参数。
      结果  两种计划的计划肿瘤靶区(PGTV)比较, TH计划的2%的靶区体积受到的辐射剂量(D2)、98%的靶区体积受到的辐射剂量(D98)、50%的靶区体积受到的辐射剂量(D50)、适形指数(CI)高于TD计划, 其中CI的差异有统计学意义(P < 0.05);两种计划的计划靶区(PTV)比较, TH计划D98和CI高于TD计划, D50低于TD计划, 但TD计划D2略优于TH, 差异均有统计学意义(P < 0.05)。TD计划的左肺受到5 Gy辐射剂量的体积(V5)、受到10 Gy辐射剂量的体积(V10)、受到20 Gy辐射剂量的体积(V20), 右肺V5、平均辐射剂量(Dmean), 右乳腺Dmean, 脊髓D2以及心脏Dmean均低于TH计划, 差异均有统计学意义(P < 0.05)。
      结论  左乳癌保乳术后瘤床同步推量放疗TH和TD均能满足临床剂量学要求, 而对危及器官的保护上, TD明显优于TH, 对乳腺癌保乳术后有心肺疾患和化疗后心脏损伤患者建议优先选择TD技术。

     

    Abstract:
      Objective  To explore the dosimetric characteristics of TomoHelical (TH) and TomoDirect (TD) with simultaneous integrated boost for silver clip marked tumor bed after breast-conserving surgery of left breast cancer.
      Methods  Totally 20 patients with breast-conserving surgery of left breast cancer were selected, and TOMO therapeutic planning system was used to design TH plan and TD plan. The dosimetry parameters of the two plans were analyzed.
      Results  In the comparison of planning gross tumor volume (PGTV) between the two plans, the radiation dose to 2% of the target volume (D2), the radiation dose to 98% of the target volume (D98), the radiation dose to 50% of the target volume (D50) and the conformal index (CI) of the TH plan were higher than those of the TD plan, and the significant difference was observed in CI between two plans (P < 0.05). In the comparison of planning tumor volume (PTV) between the two plans, theD98 and CI of the TH plan were significantly higher than those of the TD plan, D50 was significantly lower than that of the TD plan, but D2 of the TD plan was significantly better than that of the TH plan (P < 0.05). The volume of left lung exposed to 5 Gy radiation dose (V5), 10 Gy radiation dose (V10) and 20 Gy radiation dose (V20), V5 and mean radiation dose (Dmean) of right lung, Dmean of right breast, D2 of spinal cord and Dmean of heart in the TD plan were significantly lower than those in the TH plan (P < 0.05).
      Conclusion  Both TH and TD can meet the clinical dosimetry requirements of simultaneous integrated boost for patients with silver clip marked tumor bed after breast-conserving surgery of left breast cancer, and TD is obviously better than TH in the protection of organs at risk. Therefore, it is suggested that TD technology should be the priority choice for patients with cardiopulmonary disease after breast-conserving surgery and heart injury after chemotherapy.

     

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