中南大学学报（医学版）
中南大學學報（醫學版）
중남대학학보（의학판）
JOURNAL OF CENTRAL SOUTH UNIVERSITY (MEDICAL SCIENCES)
2013年
10期
1003-1008
,共6页
欧阳淑玉%贺礼理%谢小雪%周琴%匡韦陆%申良方
歐暘淑玉%賀禮理%謝小雪%週琴%劻韋陸%申良方
구양숙옥%하례리%사소설%주금%광위륙%신량방
乳腺肿瘤%调强放射治疗%混合调强放射治疗%剂量分布
乳腺腫瘤%調彊放射治療%混閤調彊放射治療%劑量分佈
유선종류%조강방사치료%혼합조강방사치료%제량분포
breast neoplasm%intensity modulated radiation therapy%hybrid intensity modulated radiation therapy%dose distribution
目的：比较左侧乳腺癌保乳术后两种调强放疗计划的剂量学差异，评价两种计划的剂量学特点，为临床治疗方法的优选提供依据。方法：选择8例左侧乳腺癌保乳术后患者，利用三维治疗计划系统为每例患者分别设计调强放射治疗计划(IMRT)和混合调强放射治疗计划(Hybrid IMRT)。在剂量体积直方图(DVH)上比较靶区和正常组织器官照射剂量、不均匀指数和适形指数。结果：在具有相同覆盖率(V95%)的情况下，Hybrid IMRT的靶区剂量均匀度优于IMRT。两种计划的适形指数，V105%，V110%，最大剂量(Dmax)，最小剂量(Dmin)，平均剂量(Dmean)均无显著差异。Hybrid IMRT和IMRT相比，同侧肺接受13 Gy的体积(V13)由27.66%降至20.7%，对侧肺V5由8.01%降至2.25%；心脏V10，V20分别由35.23%，16.77%降至19.22%，10.6%；对侧乳腺V5，V10分别由35%，10.39%降至20.38%，5.7%，差异均具有统计学意义(P<0.05)；而对于同侧肺V30，V40及心脏V40，分别升高了1.28%，1.48%，2.48%，差异有统计学意义(P<0.05)。结论：在乳腺癌患者放疗体位重复性不太好和(或)摆位精确性不能保证的情况下，混合调强放疗技术是更好的选择。
目的：比較左側乳腺癌保乳術後兩種調彊放療計劃的劑量學差異，評價兩種計劃的劑量學特點，為臨床治療方法的優選提供依據。方法：選擇8例左側乳腺癌保乳術後患者，利用三維治療計劃繫統為每例患者分彆設計調彊放射治療計劃(IMRT)和混閤調彊放射治療計劃(Hybrid IMRT)。在劑量體積直方圖(DVH)上比較靶區和正常組織器官照射劑量、不均勻指數和適形指數。結果：在具有相同覆蓋率(V95%)的情況下，Hybrid IMRT的靶區劑量均勻度優于IMRT。兩種計劃的適形指數，V105%，V110%，最大劑量(Dmax)，最小劑量(Dmin)，平均劑量(Dmean)均無顯著差異。Hybrid IMRT和IMRT相比，同側肺接受13 Gy的體積(V13)由27.66%降至20.7%，對側肺V5由8.01%降至2.25%；心髒V10，V20分彆由35.23%，16.77%降至19.22%，10.6%；對側乳腺V5，V10分彆由35%，10.39%降至20.38%，5.7%，差異均具有統計學意義(P<0.05)；而對于同側肺V30，V40及心髒V40，分彆升高瞭1.28%，1.48%，2.48%，差異有統計學意義(P<0.05)。結論：在乳腺癌患者放療體位重複性不太好和(或)襬位精確性不能保證的情況下，混閤調彊放療技術是更好的選擇。
목적：비교좌측유선암보유술후량충조강방료계화적제량학차이，평개량충계화적제량학특점，위림상치료방법적우선제공의거。방법：선택8례좌측유선암보유술후환자，이용삼유치료계화계통위매례환자분별설계조강방사치료계화(IMRT)화혼합조강방사치료계화(Hybrid IMRT)。재제량체적직방도(DVH)상비교파구화정상조직기관조사제량、불균균지수화괄형지수。결과：재구유상동복개솔(V95%)적정황하，Hybrid IMRT적파구제량균균도우우IMRT。량충계화적괄형지수，V105%，V110%，최대제량(Dmax)，최소제량(Dmin)，평균제량(Dmean)균무현저차이。Hybrid IMRT화IMRT상비，동측폐접수13 Gy적체적(V13)유27.66%강지20.7%，대측폐V5유8.01%강지2.25%；심장V10，V20분별유35.23%，16.77%강지19.22%，10.6%；대측유선V5，V10분별유35%，10.39%강지20.38%，5.7%，차이균구유통계학의의(P<0.05)；이대우동측폐V30，V40급심장V40，분별승고료1.28%，1.48%，2.48%，차이유통계학의의(P<0.05)。결론：재유선암환자방료체위중복성불태호화(혹)파위정학성불능보증적정황하，혼합조강방료기술시경호적선택。
Objective: To evaluate the potential dosimetric beneifts and optimal indications of intensity modulated radiation therapy (IMRT) and hybrid intensity modulated radiation therapy (Hybrid IMRT) for the left side breast cancer patients after breast-conservation therapy. <br> Methods: Eight patients with left breast carcinoma who received breast-conservation surgery were selected for this study. Two plans were designed in 3-dimensional treatment planning system. The dose distributions of target volume and normal tissues, conformal index (CI) and heterogeneous index (HI) were analyzed by dose-volume histogram (DVH). <br> Results: The PTV coverage was the same in the two radiotherapy plans. A better dose uniformity throughout the whole breast in Hybrid IMRT plan was achieved. The CI, the percentage of PTV receiving more than 105% prescribed dose (V105%), the percentage of PTV receiving more than 110% prescribed dose (V110%), and the Dmax, Dmin and Dmean of PTV were similar in the two plans. We compared the Hybrid IMRT with IMRT: V13of the ipsilateral lung decreased from 27.66% to 20.7%, V5 of the contralateral lung decreased from 8.01% to 2.25%, V10 and V20 of the heart decreased from 35.23% and 16.77% to 19.22% and 10.6% respectively, V5 and V10 of the contralateral breast decreased from 35% and 10.39% to 20.38% and 5.7% respectively, all with significant difference. V30 and V40 of the ipsilateral lung and V40 of the heart increased by 1.28%, 1.48%, and 2.48%, with signiifcant difference. <br> Conclusion: Hybrid IMRT is a better choice for patients whose treatment position is inaccurate or cannot be repeated well.
