CAJ | 학술논문

目的运用蒙特卡罗算法指导乳腺癌IORT剂量优化并评价临床应用效果.方法利用MCTP的MCBEAM程序建立加速器乳腺癌IORT的模型,采用自主开发的编辑器将乳腺癌患者术前CT图像编辑成术中状态影像,勾画靶区并分别在靶区前后设置不同厚度等效材料和铅板,通过MCSIM程序运算得到等效材料与铅板最佳优化组合.将优化组合应用于23例IORT患者并观察伤口愈合、不良反应、美容效果和肿瘤复发情况.结果靶区表面加2 ～3 mm等效材料、靶区后缘加5 mm等效材料和2 mm铅板,优化的乳腺癌IORT靶区剂量90％等剂量线基本包绕整个靶区,靶区V9o＞90％、V110＜4％,肺Dmean＜1Gy.23例患者伤口均愈合良好,未出现感染及不良反应,愈合后和术后半年乳房外观优良率达80％以上,未发现肿瘤复发.结论蒙特卡罗算法指导下的乳腺癌IORT剂量优化方法可靠,靶区剂量分布均匀、理想,患者无不良反应,美容效果满意,值得临床推广应用.
목적 운용몽특잡라산법지도유선암IORT제량우화병평개림상응용효과.방법 이용MCTP적MCBEAM정서건립가속기유선암IORT적모형,채용자주개발적편집기장유선암환자술전CT도상편집성술중상태영상,구화파구병분별재파구전후설치불동후도등효재료화연판,통과MCSIM정서운산득도등효재료여연판최가우화조합.장우화조합응용우23례IORT환자병관찰상구유합、불량반응、미용효과화종류복발정황.결과 파구표면가2 ～3 mm등효재료、파구후연가5 mm등효재료화2 mm연판,우화적유선암IORT파구제량90％등제량선기본포요정개파구,파구V9o＞90％、V110＜4％,폐Dmean＜1Gy.23례환자상구균유합량호,미출현감염급불량반응,유합후화술후반년유방외관우량솔체80％이상,미발현종류복발.결론 몽특잡라산법지도하적유선암IORT제량우화방법가고,파구제량분포균균、이상,환자무불량반응,미용효과만의,치득림상추엄응용.
Objective To study Monte Carlo simulation to guide the dose optimization of intraoperative radiotherapy (IORT) for breast cancer,and evaluating its effects of clinical application.Methods The MCBEAM program of MCTP is used to establish the model of the accelerator using for breast cancer patients' IORP.The preoperative CT images are edited to intra-operative states using independent developed editor,then determing the target at the intra-operative states and setting equivalent material and lead of different thicknesses in front of and behind the target.Calculating with the MCSIM program to get the optimal combination of the equivalent material and lead.There are 23 patients who accepted IORT with the optical combination of themselves,and the situations of wounds healing,reactions of radiotherapy,cosmetic effects and the recurrence of cancer are observed.Results By adding 2-3 mm equivalent material in front of the target and 5 mm equivalent material and 2 mm lead behind the target,the 90％ isodose curve almost wraps around the target volume;and the V90 ＞90％ and the V110 ＜4％.The average dose of lung is less than 1 Gy.The 23 patients' wounds healed well,and there are no wounds' infection and radiotherapy reaction;after the healing of wounds and half a year after the operation,the excellent rate of breasts' appearance is over 80％,and no tumor recurrence was found.Conclusions The method of MC guided dose optimization of IORT for breast cancer is reliable,the dose distribution of target volume is uniform.There were no adverse reactions to radiotherapy and the cosmetic effect is satisfying.This method is well worthy of clinical popularizing.