中华生物医学工程杂志
中華生物醫學工程雜誌
중화생물의학공정잡지
CHINESE JOURNAL OF BIOMEDICAL ENGINEERING
2015年
1期
59-63
,共5页
李军%花威%张西志%汪步海%张先稳%汤晓斌%陈达
李軍%花威%張西誌%汪步海%張先穩%湯曉斌%陳達
리군%화위%장서지%왕보해%장선은%탕효빈%진체
乳腺肿瘤%放射肿瘤学%放射治疗剂量
乳腺腫瘤%放射腫瘤學%放射治療劑量
유선종류%방사종류학%방사치료제량
Breast neoplasms%Radiation oncology%Radiotherapy dosage
目的:探讨左侧乳腺癌术后3种不同放疗计划的剂量学差异。方法收集江苏省苏北人民医院2011年3月至2013年3月期间收治的15例左侧乳腺癌术后患者,分别设计3D?CRT、dIMRT和RapidArc计划,处方剂量均为5000 cGy。利用剂量体积直方图分析临床靶区(CTV)、危及器官(OAR)的评价指标,包括CTV的平均剂量Dmean、最大剂量Dmax(D2%)和最小剂量Dmin(D98%),靶区剂量均匀性指数HI,靶区适合度指数CI,以及两侧肺接受5、20、30 Gy的体积百分比V5、V10、V20、V30和平均剂量Dmean,对侧乳腺的平均剂量Dmean、D1%,心脏的Dmean、V10,脊髓1%体积接受照射的最大剂量D1%。结果3D?CRT计划CTV各评价指标中除HI、D2%外,均劣于dIMRT和RapidArc计划(均P<0.05)。dIMRT和RapidArc计划相比,仅在Dmean、V95%的差异有统计学意义(均P<0.05),且以RapidArc计划Dmean更接近处方剂量,V95%覆盖率较高达97.44%。对于患侧肺,3种计划中3D?CRT的V5、V10最低(均P<0.05),而V20、V30最高(均P<0.05),而RapidArc和dIMRT患侧肺V5、V10稍高(均P<0.05)。对侧肺和心脏3D?CRT各评价指标最低(均P<0.05)。对侧乳腺D1%则以dIMRT和RapidArc计划较低,分别为(1770.89±121.16)cGy和(1839.92±92.77)cGy。而脊髓D1% dIMRT和RapidArc计划较高,分别为(1990.12±61.52)cGy和(1927.38±43.67)cGy。正常组织接受剂量为5~15 Gy体积时3D?CRT计划明显最低,而RapidArc计划相对较高。RapidArc计划的MU数和治疗时间最少,仅为dIMRT计划的49.33%和55.86%。结论3种计划均能够满足乳腺癌术后放疗的临床剂量学要求。dIMRT和RapidArc计划靶区适形度更优,且RapidArc计划具有较少总MU数和较短的总治疗时间的优势。
目的:探討左側乳腺癌術後3種不同放療計劃的劑量學差異。方法收集江囌省囌北人民醫院2011年3月至2013年3月期間收治的15例左側乳腺癌術後患者,分彆設計3D?CRT、dIMRT和RapidArc計劃,處方劑量均為5000 cGy。利用劑量體積直方圖分析臨床靶區(CTV)、危及器官(OAR)的評價指標,包括CTV的平均劑量Dmean、最大劑量Dmax(D2%)和最小劑量Dmin(D98%),靶區劑量均勻性指數HI,靶區適閤度指數CI,以及兩側肺接受5、20、30 Gy的體積百分比V5、V10、V20、V30和平均劑量Dmean,對側乳腺的平均劑量Dmean、D1%,心髒的Dmean、V10,脊髓1%體積接受照射的最大劑量D1%。結果3D?CRT計劃CTV各評價指標中除HI、D2%外,均劣于dIMRT和RapidArc計劃(均P<0.05)。dIMRT和RapidArc計劃相比,僅在Dmean、V95%的差異有統計學意義(均P<0.05),且以RapidArc計劃Dmean更接近處方劑量,V95%覆蓋率較高達97.44%。對于患側肺,3種計劃中3D?CRT的V5、V10最低(均P<0.05),而V20、V30最高(均P<0.05),而RapidArc和dIMRT患側肺V5、V10稍高(均P<0.05)。對側肺和心髒3D?CRT各評價指標最低(均P<0.05)。對側乳腺D1%則以dIMRT和RapidArc計劃較低,分彆為(1770.89±121.16)cGy和(1839.92±92.77)cGy。而脊髓D1% dIMRT和RapidArc計劃較高,分彆為(1990.12±61.52)cGy和(1927.38±43.67)cGy。正常組織接受劑量為5~15 Gy體積時3D?CRT計劃明顯最低,而RapidArc計劃相對較高。RapidArc計劃的MU數和治療時間最少,僅為dIMRT計劃的49.33%和55.86%。結論3種計劃均能夠滿足乳腺癌術後放療的臨床劑量學要求。dIMRT和RapidArc計劃靶區適形度更優,且RapidArc計劃具有較少總MU數和較短的總治療時間的優勢。
목적:탐토좌측유선암술후3충불동방료계화적제량학차이。방법수집강소성소북인민의원2011년3월지2013년3월기간수치적15례좌측유선암술후환자,분별설계3D?CRT、dIMRT화RapidArc계화,처방제량균위5000 cGy。이용제량체적직방도분석림상파구(CTV)、위급기관(OAR)적평개지표,포괄CTV적평균제량Dmean、최대제량Dmax(D2%)화최소제량Dmin(D98%),파구제량균균성지수HI,파구괄합도지수CI,이급량측폐접수5、20、30 Gy적체적백분비V5、V10、V20、V30화평균제량Dmean,대측유선적평균제량Dmean、D1%,심장적Dmean、V10,척수1%체적접수조사적최대제량D1%。결과3D?CRT계화CTV각평개지표중제HI、D2%외,균렬우dIMRT화RapidArc계화(균P<0.05)。dIMRT화RapidArc계화상비,부재Dmean、V95%적차이유통계학의의(균P<0.05),차이RapidArc계화Dmean경접근처방제량,V95%복개솔교고체97.44%。대우환측폐,3충계화중3D?CRT적V5、V10최저(균P<0.05),이V20、V30최고(균P<0.05),이RapidArc화dIMRT환측폐V5、V10초고(균P<0.05)。대측폐화심장3D?CRT각평개지표최저(균P<0.05)。대측유선D1%칙이dIMRT화RapidArc계화교저,분별위(1770.89±121.16)cGy화(1839.92±92.77)cGy。이척수D1% dIMRT화RapidArc계화교고,분별위(1990.12±61.52)cGy화(1927.38±43.67)cGy。정상조직접수제량위5~15 Gy체적시3D?CRT계화명현최저,이RapidArc계화상대교고。RapidArc계화적MU수화치료시간최소,부위dIMRT계화적49.33%화55.86%。결론3충계화균능구만족유선암술후방료적림상제량학요구。dIMRT화RapidArc계화파구괄형도경우,차RapidArc계화구유교소총MU수화교단적총치료시간적우세。
Objective To investigate the difference in dosimetry among three different plans for postoperative radiotherapy of the left breast cancer. Methods Between March 2011 and March 2013,a total of 15 postoperative patients with left breast cancer in Subei People ’s Hospital of Jiangsu Province received radiotherapy based on 3D?CRT,dIMRT or RapidArc planning,with a prescribed dose of 5 000 cGy. Dose volume histogram analysis was used to show the evaluation measures of clinical target volume (CTV)and organ at risk(OAR)which include the mean(Dmean),maximum(D2%)and minimum(D98%) doses of CTV,homogeneity index(HI)and conformity index(CI)of the CTV,percentage volumes with 5 (V5),10(V10),20(V20)and 30(V30)Gy and mean dose(Dmean)of the lung,Dmean and D1% of the contralateral breast,Dmean and V10 of the heart,D1% of the spinal cord with 1% of its volume subjected to radiation. Results Except for the HI and D2%,evaluation measures of 3D?CRT plan were inferior to those of dIMRT and RapidArc plans (all P<0.05). Between dIMRT and RapidArc plan,only Dmean and V95%differed(all P<0.05);with RapidArc plan,the Dmean was closer to the prescription dose,and the V95%coverage rate was as high as 97. 44%. At the ipsilateral lung,3D?CRT yielded the lowest V5 and V10(all P<0.05)and highest V20 and V30(all P<0.05),while the RapidArc and dIMRT yielded moderate values of V5 and V10(all P<0. 05). The 3D?CRT yielded the lowest of each evaluation measure at the contralateral lung and heart(all P<0.05). The contralateral breast D1%was lower with dIMRT[(1 770.89±121.16)cGy]and RapidArc[(1 839.92±92.77)cGy]plans. The dIMRT and RapidArc plans yielded higher D1%of the spinal cord[(1 990.12 ± 61.52)cGy and(1 927.38 ± 43.67)cGy,respectively]. The 3D?CRT plan yielded the lowest percentage volumes of normal tissue with the radiation doses ranging from 5 to 15 Gy. RapidArc plan took less MU and treatment time,which account for only 49.33% and 55.86%,respectively,of those in dIMRT plan. Conclusion All of the three plans are able to meet the requirement of clinical dosimetry in the postoperative radiotherapy for left breast cancer. The dIMRT and RapidArc plans may be more conformable for the target volume;in addition,and RapidArc plan is more advantageous in terms of less total MU and treatment time.