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
2014年
12期
946-950
,共5页
铁剑%张健%张艺宝%吴昊
鐵劍%張健%張藝寶%吳昊
철검%장건%장예보%오호
乳腺癌%保留乳腺治疗%调强放疗%俯卧位%剂量学
乳腺癌%保留乳腺治療%調彊放療%俯臥位%劑量學
유선암%보류유선치료%조강방료%부와위%제량학
Breast cancer%Breast-conserving therapy%Intensity modulated radiation therapy%Prone setup%Dosimetry
目的 比较早期乳腺癌保乳术后仰卧位与俯卧位调强治疗计划靶区和危及器官的剂量学差异.方法 选取15例接受保乳术后放疗的大乳腺及乳腺下垂的左侧乳腺癌患者,分别进行仰卧位及俯卧位CT定位扫描,利用相同优化条件分别进行切线2野调强治疗计划设计.比较2种不同体位计划的靶区剂量分布、心脏、左肺及右侧乳腺受照剂量和体积,以及机器跳数的差异.结果 俯卧位调强计划适形度指数(CI)优于仰卧位计划(0.79±0.05 vs.0.72 ±0.04,W=138,P＜0.01),均匀性指数(HI)也优于仰卧位计划(1.09 ±0.01 vs.1.12±0.02,t=-4.7,P＜0.01).俯卧位计划靶区接受95％处方剂量照射的百分体积(V95％)、最小剂量(Dmin)大于仰卧位计划(t=7.1、6.4,P＜0.01),平均剂量(Dmean)大于仰卧位计划(W=153,P＜0.01),最大剂量(Dmax)小于仰卧位计划(t=-3.6,P＜0.01).仰卧位计划的右乳接受5 Gy照射的百分体积(V5)小于俯卧位计划(W=160,P＜0.01),心脏接受30 Gy照射的百分体积(V30)大于俯卧位计划(t=5.4,P＜0.01),心脏平均剂量(Dmean)、左肺接受20和5 Gy照射的百分体积(V20、V5)明显大于俯卧位计划(W=133、120、120,P＜0.01).机器跳数间差异无统计学意义.结论 对于大乳腺及乳腺下垂乳腺癌患者,保乳术后俯卧位调强计划与仰卧位调强计划相比,靶区剂量分布更均匀,心、肺受照射剂量和体积明显减少.
目的 比較早期乳腺癌保乳術後仰臥位與俯臥位調彊治療計劃靶區和危及器官的劑量學差異.方法 選取15例接受保乳術後放療的大乳腺及乳腺下垂的左側乳腺癌患者,分彆進行仰臥位及俯臥位CT定位掃描,利用相同優化條件分彆進行切線2野調彊治療計劃設計.比較2種不同體位計劃的靶區劑量分佈、心髒、左肺及右側乳腺受照劑量和體積,以及機器跳數的差異.結果 俯臥位調彊計劃適形度指數(CI)優于仰臥位計劃(0.79±0.05 vs.0.72 ±0.04,W=138,P＜0.01),均勻性指數(HI)也優于仰臥位計劃(1.09 ±0.01 vs.1.12±0.02,t=-4.7,P＜0.01).俯臥位計劃靶區接受95％處方劑量照射的百分體積(V95％)、最小劑量(Dmin)大于仰臥位計劃(t=7.1、6.4,P＜0.01),平均劑量(Dmean)大于仰臥位計劃(W=153,P＜0.01),最大劑量(Dmax)小于仰臥位計劃(t=-3.6,P＜0.01).仰臥位計劃的右乳接受5 Gy照射的百分體積(V5)小于俯臥位計劃(W=160,P＜0.01),心髒接受30 Gy照射的百分體積(V30)大于俯臥位計劃(t=5.4,P＜0.01),心髒平均劑量(Dmean)、左肺接受20和5 Gy照射的百分體積(V20、V5)明顯大于俯臥位計劃(W=133、120、120,P＜0.01).機器跳數間差異無統計學意義.結論 對于大乳腺及乳腺下垂乳腺癌患者,保乳術後俯臥位調彊計劃與仰臥位調彊計劃相比,靶區劑量分佈更均勻,心、肺受照射劑量和體積明顯減少.
목적 비교조기유선암보유술후앙와위여부와위조강치료계화파구화위급기관적제량학차이.방법 선취15례접수보유술후방료적대유선급유선하수적좌측유선암환자,분별진행앙와위급부와위CT정위소묘,이용상동우화조건분별진행절선2야조강치료계화설계.비교2충불동체위계화적파구제량분포、심장、좌폐급우측유선수조제량화체적,이급궤기도수적차이.결과 부와위조강계화괄형도지수(CI)우우앙와위계화(0.79±0.05 vs.0.72 ±0.04,W=138,P＜0.01),균균성지수(HI)야우우앙와위계화(1.09 ±0.01 vs.1.12±0.02,t=-4.7,P＜0.01).부와위계화파구접수95％처방제량조사적백분체적(V95％)、최소제량(Dmin)대우앙와위계화(t=7.1、6.4,P＜0.01),평균제량(Dmean)대우앙와위계화(W=153,P＜0.01),최대제량(Dmax)소우앙와위계화(t=-3.6,P＜0.01).앙와위계화적우유접수5 Gy조사적백분체적(V5)소우부와위계화(W=160,P＜0.01),심장접수30 Gy조사적백분체적(V30)대우부와위계화(t=5.4,P＜0.01),심장평균제량(Dmean)、좌폐접수20화5 Gy조사적백분체적(V20、V5)명현대우부와위계화(W=133、120、120,P＜0.01).궤기도수간차이무통계학의의.결론 대우대유선급유선하수유선암환자,보유술후부와위조강계화여앙와위조강계화상비,파구제량분포경균균,심、폐수조사제량화체적명현감소.
Objective To compare the dosimetric differences of the targets and organs at risk (OARs) for early stage breast cancer patients receiving intensity modulated radiotherapy (IMRT) with supine or prone setups after breast conserving surgery.Methods After breast conserving surgery,15 left breast cancer patients with large and pendulous breasts were selected.Their planning CT images were acquired with supine and prone orientations respectively,based on which IMRT plans of 2 tangential fields were developed using the same optimization parameters.Treatment plans of the two setups were evaluated by comparing the target dose distribution,the doses and irradiated volumes of the heart,left lung,and right breast,and the monitor units (MUs).Results Superior conformal index (CI) was observed in the plans of prone setup than the supine cases (0.79 ± 0.05 vs.0.72 ± 0.04,W =138,P ＜ 0.01).The homogeneity index (HI) of prone positioning was also better than that of supine setup (1.09 ±0.01 vs.1.12 ± 0.02,t =-4.7,P ＜0.01).The planning target volume (PTV) receiving 95％ of prescribed dose (V95％),and the minimum doses (Dmin) of the prone cases were significantly higher than the supine patients (t =7.1,6.4,P＜0.01).Higher mean doses (D) were observed in prone cases (W=153,P＜0.01).The maximum doses (Dmax) of the supine plans were lower than the prone cases (t =-3.6,P ＜0.01).The right breast volumes receiving 5 Gy doses or higher (V5) were less in the supine cases than the prone plans (W=160,P ＜0.01).The heart volumes received no less than 30 Gy (V30),D of the heart,and the left lung volumes received higher than 20 Gy or 5 Gy (V20,V5) of the supine plans were significantly higher than the prone cases (W =133,120,120,P ＜0.01).No significant difference was observed on the MUs.Conclusions For cancer patients with large and pendulous breasts receiving IMRT after breast conserving surgery,prone setup leads to better homogeneity of target dose distribution,and reduces the doses and irradiated volumes of the heart and lungs.
