中国医疗前沿
中國醫療前沿
중국의료전연
CHINA HEALTHCARE INNOVATION
2013年
11期
6-8
,共3页
王晓红%谭文勇%柳栋%胡德胜%陈正望
王曉紅%譚文勇%柳棟%鬍德勝%陳正望
왕효홍%담문용%류동%호덕성%진정망
乳腺癌%调强放疗%危及器官%左心室%心脏并发症
乳腺癌%調彊放療%危及器官%左心室%心髒併髮癥
유선암%조강방료%위급기관%좌심실%심장병발증
Breast cancer%Intensity modulation radiation therapy%Left ventricle%Organ at risk%Cardiac complication
目的探索心脏前壁区域(anterior myocardial territory，AMT)作为独立的危及器官在左乳腺癌保乳术后放疗中心脏保护的可行性。方法随机选取23例左乳癌接受保乳术后及术后辅助放疗的患者的计划CT图像。由同一个放疗医师勾画靶区和危及器官(OAR)，OAR包括心脏(H)、AMT、左心室(left ventricle, LV)、左右肺和右侧乳腺。每个患者由物理师设计两个调强治疗计划(IMRT)，一个是以AMT作为目标函数，另一个是以H+LV作为目标函数。所有治疗计划的处方剂量均为50Gy，25次。比较计划靶区(PTV)、AMT、LV、心脏、左右肺和右侧乳腺的剂量体积参数。结果 IMRT(AMT)和IMRT(H+LV)2个计划的PTV剂量的均匀指数、适形指数、覆盖指数均无明显差别。与IMRT(AMT)计划相比，IMRT(H+LV)中AMT的最大剂量明显增加，平均剂量增加有统计学意义，AMT的V12Gy、V13Gy、V15Gy、V17Gy和V20Gy分别增加15.37%、18.87%、26.48%、27.11%(P <0.05)，LV的V5Gy、V7Gy、V8Gy和V10Gy分别增加4.21%、16.72%、20.91%和19.14%(P <0.05)。心脏和左肺的各个剂量体积参数无统计学差别，多数右肺和右乳腺的剂量体积参数无明显统计学差别。结论在左乳腺癌术后放疗中，AMT可作为替代心脏的一个独立危及器官可明显降低心脏照射剂量。
目的探索心髒前壁區域(anterior myocardial territory，AMT)作為獨立的危及器官在左乳腺癌保乳術後放療中心髒保護的可行性。方法隨機選取23例左乳癌接受保乳術後及術後輔助放療的患者的計劃CT圖像。由同一箇放療醫師勾畫靶區和危及器官(OAR)，OAR包括心髒(H)、AMT、左心室(left ventricle, LV)、左右肺和右側乳腺。每箇患者由物理師設計兩箇調彊治療計劃(IMRT)，一箇是以AMT作為目標函數，另一箇是以H+LV作為目標函數。所有治療計劃的處方劑量均為50Gy，25次。比較計劃靶區(PTV)、AMT、LV、心髒、左右肺和右側乳腺的劑量體積參數。結果 IMRT(AMT)和IMRT(H+LV)2箇計劃的PTV劑量的均勻指數、適形指數、覆蓋指數均無明顯差彆。與IMRT(AMT)計劃相比，IMRT(H+LV)中AMT的最大劑量明顯增加，平均劑量增加有統計學意義，AMT的V12Gy、V13Gy、V15Gy、V17Gy和V20Gy分彆增加15.37%、18.87%、26.48%、27.11%(P <0.05)，LV的V5Gy、V7Gy、V8Gy和V10Gy分彆增加4.21%、16.72%、20.91%和19.14%(P <0.05)。心髒和左肺的各箇劑量體積參數無統計學差彆，多數右肺和右乳腺的劑量體積參數無明顯統計學差彆。結論在左乳腺癌術後放療中，AMT可作為替代心髒的一箇獨立危及器官可明顯降低心髒照射劑量。
목적탐색심장전벽구역(anterior myocardial territory，AMT)작위독립적위급기관재좌유선암보유술후방료중심장보호적가행성。방법수궤선취23례좌유암접수보유술후급술후보조방료적환자적계화CT도상。유동일개방료의사구화파구화위급기관(OAR)，OAR포괄심장(H)、AMT、좌심실(left ventricle, LV)、좌우폐화우측유선。매개환자유물리사설계량개조강치료계화(IMRT)，일개시이AMT작위목표함수，령일개시이H+LV작위목표함수。소유치료계화적처방제량균위50Gy，25차。비교계화파구(PTV)、AMT、LV、심장、좌우폐화우측유선적제량체적삼수。결과 IMRT(AMT)화IMRT(H+LV)2개계화적PTV제량적균균지수、괄형지수、복개지수균무명현차별。여IMRT(AMT)계화상비，IMRT(H+LV)중AMT적최대제량명현증가，평균제량증가유통계학의의，AMT적V12Gy、V13Gy、V15Gy、V17Gy화V20Gy분별증가15.37%、18.87%、26.48%、27.11%(P <0.05)，LV적V5Gy、V7Gy、V8Gy화V10Gy분별증가4.21%、16.72%、20.91%화19.14%(P <0.05)。심장화좌폐적각개제량체적삼수무통계학차별，다수우폐화우유선적제량체적삼수무명현통계학차별。결론재좌유선암술후방료중，AMT가작위체대심장적일개독립위급기관가명현강저심장조사제량。
Objective To investigate the feasibility of anterior myocardial territory(AMT) as an independent organ at risk(OAR) in postoperative intensity modulated radiotherapy(IMRT) for left-sided breast cancer patients who received breast conserved surgery(BCS) to avoid unnecessary cardiac radiation. Methods The archived computed tomographic(CT) scans of 23 patients who received adjuvant radiotherapy were selected randomly for this dosimetric study. The same radiation oncologist delineated the clinical target volume(CTV) and OARs including both lungs, the right breast, the heart, left ventricle(LV), AMT and the same physicist designed two IMRT plans including IMRT(H+LV) and H(AMT) plan. The prescribed dose(PD) was 50Gy with 25 fractions. For the planning target volume(PTV) and OARs, the various dose-volume histogram(DVH) parameters were compared with paired t-test. Results For the PTV, the homogeneity index, conformity index, and coverage index of both IMRT plans were not different statistically. Compared with IMRT(AMT), The maximal dose to AMT increased significantly and mean dose to AMT increased without statistical difference(P =0.069), the V12Gy, V13Gy, V15Gy, V17Gy and V20Gy increased 15.37%, 18.87%, 26.48%, 27.11% and 26.04% respectively(P <0.05), and the V5Gy, V7Gy, V8Gy and V10Gy of LV did 4.21%、16.72%、20.91%and 19.14%(P <0.05). All the dose-volume parameters of the heart and LV as well as majority of the dose-volume parameters of right lung and breast were not different statistically. Conclusion For left-sided breast patients with breast conserved surgery,anterior myocardial territory replaced the heart as an independent OAR may decrease the cardiac dose in the postoperative radiotherapy.
