中华放射医学与防护杂志
中華放射醫學與防護雜誌
중화방사의학여방호잡지
Chinese Journal of Radiological Medicine and Protection
2011年
3期
317-321
,共5页
铁剑%孙艳%弓健%韩树奎%蒋皤%吴昊
鐵劍%孫豔%弓健%韓樹奎%蔣皤%吳昊
철검%손염%궁건%한수규%장파%오호
乳腺癌%保乳手术%调强放疗%容积调强放疗%剂量学比较
乳腺癌%保乳手術%調彊放療%容積調彊放療%劑量學比較
유선암%보유수술%조강방료%용적조강방료%제량학비교
Breast cancer%Breast-conserving surgery%Intensity modulated radiation therapy%Volumetric modulated are therapy%Dosimetry
目的 比较早期乳腺癌保乳术后固定野动态调强与容积调强放疗治疗靶区和危及器官的剂量学差异.方法 20例左侧乳腺癌患者(均女性,24～75岁)保乳术后接受放疗,在同一患者CT影像上分别进行2野共面动态调强和容积调强(RapidArc)两种治疗计划设计.在剂量-体积直方图中读取两种计划的靶区剂量分布参数,心脏、双侧肺及对侧乳腺受照剂量和体积,对各参数的均数进行比较;并比较两者平均机器跳数和平均治疗时间的差异.结果 RapidArc较IMRT计划CTV V95%增加了0.65%(t=5.16,P=0.001),V105%下降了10.96%(t=-2.05,P=0.055),V110%下降了1.48%(t=-1.33,P=0.197).RapidArc计划的适形指数(CI)和均匀性指数(HI)均优于IMRT治疗计划,分别为0.88±0.02 vs 0.74±0.03(t=18.54,P＜0.001),1.11±0.01 Vs 1.12±0.02(t=-2.44,P=0.025).两种计划中左肺V20和Dmax比较差异无统计学意义,但在RapidArc计划中V10、V5、Dmix、Dmean明显增高,V5增高了接近30%.心脏V30和Dmax在两计划中无明显差异,而RapidArc计划的V10增加了18%,V5增加50%.RapidArc计划的右乳V5和右肺V5较IMRT分别增加了9.33%(t=9.31,P＜0.001)和3.04%(t=5.64,P＜0.001).RapidArc和IMRT平均机器跳数分别是608和437 MU(t=10.86,P＜0.001),平均治疗时间111.3和103.6 s(t=3.57,P=0.002).结论 早期乳腺癌保乳术后全乳腺RapidAre放疗与2野动态调强放疗相比,能明显改善靶区剂量分布均匀性.对于危及器官,高剂量区两种治疗计划之间无明显差异,低剂量区RapidArc的照射范围明显增加.与2野动态调强相比,RapidArc放疗机器跳数增加,治疗时间延长.
目的 比較早期乳腺癌保乳術後固定野動態調彊與容積調彊放療治療靶區和危及器官的劑量學差異.方法 20例左側乳腺癌患者(均女性,24～75歲)保乳術後接受放療,在同一患者CT影像上分彆進行2野共麵動態調彊和容積調彊(RapidArc)兩種治療計劃設計.在劑量-體積直方圖中讀取兩種計劃的靶區劑量分佈參數,心髒、雙側肺及對側乳腺受照劑量和體積,對各參數的均數進行比較;併比較兩者平均機器跳數和平均治療時間的差異.結果 RapidArc較IMRT計劃CTV V95%增加瞭0.65%(t=5.16,P=0.001),V105%下降瞭10.96%(t=-2.05,P=0.055),V110%下降瞭1.48%(t=-1.33,P=0.197).RapidArc計劃的適形指數(CI)和均勻性指數(HI)均優于IMRT治療計劃,分彆為0.88±0.02 vs 0.74±0.03(t=18.54,P＜0.001),1.11±0.01 Vs 1.12±0.02(t=-2.44,P=0.025).兩種計劃中左肺V20和Dmax比較差異無統計學意義,但在RapidArc計劃中V10、V5、Dmix、Dmean明顯增高,V5增高瞭接近30%.心髒V30和Dmax在兩計劃中無明顯差異,而RapidArc計劃的V10增加瞭18%,V5增加50%.RapidArc計劃的右乳V5和右肺V5較IMRT分彆增加瞭9.33%(t=9.31,P＜0.001)和3.04%(t=5.64,P＜0.001).RapidArc和IMRT平均機器跳數分彆是608和437 MU(t=10.86,P＜0.001),平均治療時間111.3和103.6 s(t=3.57,P=0.002).結論 早期乳腺癌保乳術後全乳腺RapidAre放療與2野動態調彊放療相比,能明顯改善靶區劑量分佈均勻性.對于危及器官,高劑量區兩種治療計劃之間無明顯差異,低劑量區RapidArc的照射範圍明顯增加.與2野動態調彊相比,RapidArc放療機器跳數增加,治療時間延長.
목적 비교조기유선암보유술후고정야동태조강여용적조강방료치료파구화위급기관적제량학차이.방법 20례좌측유선암환자(균녀성,24～75세)보유술후접수방료,재동일환자CT영상상분별진행2야공면동태조강화용적조강(RapidArc)량충치료계화설계.재제량-체적직방도중독취량충계화적파구제량분포삼수,심장、쌍측폐급대측유선수조제량화체적,대각삼수적균수진행비교;병비교량자평균궤기도수화평균치료시간적차이.결과 RapidArc교IMRT계화CTV V95%증가료0.65%(t=5.16,P=0.001),V105%하강료10.96%(t=-2.05,P=0.055),V110%하강료1.48%(t=-1.33,P=0.197).RapidArc계화적괄형지수(CI)화균균성지수(HI)균우우IMRT치료계화,분별위0.88±0.02 vs 0.74±0.03(t=18.54,P＜0.001),1.11±0.01 Vs 1.12±0.02(t=-2.44,P=0.025).량충계화중좌폐V20화Dmax비교차이무통계학의의,단재RapidArc계화중V10、V5、Dmix、Dmean명현증고,V5증고료접근30%.심장V30화Dmax재량계화중무명현차이,이RapidArc계화적V10증가료18%,V5증가50%.RapidArc계화적우유V5화우폐V5교IMRT분별증가료9.33%(t=9.31,P＜0.001)화3.04%(t=5.64,P＜0.001).RapidArc화IMRT평균궤기도수분별시608화437 MU(t=10.86,P＜0.001),평균치료시간111.3화103.6 s(t=3.57,P=0.002).결론 조기유선암보유술후전유선RapidAre방료여2야동태조강방료상비,능명현개선파구제량분포균균성.대우위급기관,고제량구량충치료계화지간무명현차이,저제량구RapidArc적조사범위명현증가.여2야동태조강상비,RapidArc방료궤기도수증가,치료시간연장.
Objective To compare the dosimetric difference between volumetric are modulation with RapidArc and fixed field dynamic IMRT for breast cancer radiotherapy after breast-conserving surgery.Methods Twenty patients with early left-sided breast cancer received radiotherapy after breast-conserving surgery.After target definition,treatment planning was performed by RapidAre and two fixed fields dynamic IMRT respectively on the same CT scan.The target dose distribution,homogeneity of the breast,and the irradiation dose and volume for the lungs,heart,and eontralateral breast were read in the dosevolume histogram (DVH) and compared between RapidAre and IMRT.The treatment delivery time and monitor units were also compared.Results In comparison with the IMRT planning,the homogeneity of clinical target volume (CTV) ,the volume proportion of 95% prescribed dose (V95%) was significantly higher by 0.65% in RapidAre (t =5.16,P = 0.001) ,and the V105% and V110% were lower by 10.96% and 1.48 % respectively,however,without statistical significance (t =-2.05 ,P =0.055 and t =-1.33 ,P =0.197).The conformal index of planning target volume (PTV) by the Rap~dAre planning was (0.88±0.02),significantly higher than that by the IMRT planning [(0.74±0.03),t = 18.54,P < 0.001].The homogeneity index (HI) of PTV by the RapidArc planning was 1.11±0.01,significantly lower than that by the IMRT planning (1.12±0.02,t =-2.44,P =0.02).There were no significant differences in the maximum dose (Dmax) and V20 for the ipsilateral lung between the RapidArc and IMRT planning,but the values of V10,V5 ,Dmin and Dmean by RapidArc planning were all significantly higher than those by the IMRT planning (all P < 0.01).The values of max dose and V30 for the heart were similar by both techniques,but the values of V10 and V5 by the RapidArc planning were significantly higher (by 18% and 50% ,respectively).The V5 of the contralateral breast and lung by the RapidArc planning were increased by 9.33% and 3.04% respectively compared to the IMRT planning.The mean MU of the RapidArc was 608 MU,significantly higher than that by the IMRT planning (437 MU,t = 10.86,P < 0.001).The treatment time by the RapidArc planning was 111.3 s,significantly longer than that by IMRT planning (103.6 s,t = 3.57,P = 0.002).Conclusions The RapidArc planning improves the dose distribution of CTV and homogeneity of PTV for breast cancer radiotherapy after breast-conserving surgery.However,it significantly enlarges the volume of normal tissues irradiated in low dose areas,prolongs the treatment delivery time,and increases the MU value in comparison with IMRT.
