[1]王磊,倪昕晔,王根和,等. 乳腺癌固定野调强射野数目的研究[J].中国医学物理学杂志,2018,35(11):1269-1275.[doi:DOI:10.3969/j.issn.1005-202X.2018.11.006]
　WANG Lei,NI Xinye,WANG Genhe,et al. Different fixed-field intensity-modulated radiotherapy plans for breast cancer: a dosimetric comparison[J].Chinese Journal of Medical Physics,2018,35(11):1269-1275.[doi:DOI:10.3969/j.issn.1005-202X.2018.11.006]
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 乳腺癌固定野调强射野数目的研究()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
35卷
期数:
2018年第11期
页码:
1269-1275
栏目:
医学放射物理
出版日期:
2018-11-18

文章信息/Info

Title:
 Different fixed-field intensity-modulated radiotherapy plans for breast cancer: a dosimetric comparison
文章编号:
1005-202X（2018）11-1269-07
作者:
 王磊1; 倪昕晔2; 王根和1; 陈维平1; 方平1; 吴怡青1; 江大华1; 程文涛1
 1.黄山市人民医院放疗科， 安徽 黄山 245000； 2.常州市第二人民医院放疗科， 江苏 常州 213003
Author(s):
 WANG Lei1;  NI Xinye2;  WANG Genhe1;  CHEN Weiping1;  FANG Ping1;  WU Yiqing1;  JIANG Dahua1;  CHENG Wentao1
 1. Department of Radiation Oncology, Huangshan City People’s Hospital, Huangshan 245000, China; 2. Department of Radiation Oncology, Changzhou Second People’s Hospital, Changzhou 213003, China
关键词:
 ; 乳腺癌; 调强放射治疗; 射野数目; 剂量学
Keywords:
 ; Keywords: breast cancer;  intensity-modulated radiotherapy;  number of field;  dosimetry
分类号:
R811.1
DOI:
DOI:10.3969/j.issn.1005-202X.2018.11.006
文献标志码:
A
摘要:
目的：在乳腺癌改良根治术后放疗中，通过比较4种不同治疗计划的剂量分布，找出一种靶区覆盖率高、均匀性好、适形度高而正常组织受量少的治疗方式。 方法：随机选取16例乳腺癌根治术后患者制定4、5、6野调强计划（4F-IMRT、5F-IMRT、6F-IMRT）及适形混合调强治疗计划（Hybrid-IMRT），比较4种不同治疗计划的靶区和危及器官的剂量。 结果：通过数据分析可以得出，Hybrid-IMRT、5F-IMRT和6F-IMRT的CI优于4F-IMRT，差异有统计学意义（P<0.05），Hybrid-IMRT、5F-IMRT和6F-IMRT之间统计无差异（P>0.05）；4种计划的HI分别为：4F-IMRT（0.22）、5F-IMRT（0.22）、6F-IMRT（0.21）、Hybrid-IMRT（0.16），差异无统计学意义（P>0.05）；患侧肺的V5方面，Hybrid-IMRT和4F-IMRT好于5F-IMRT、6F-IMRT，V20方面，Hybrid-IMRT优于其它3种治疗计划（P<0.05），V30方面，Hybrid-IMRT明显低于4F-IMRT和6F-IMRT（P<0.05），其余治疗计划之间差异不明显（P>0.05），Dmean方面，Hybrid-IMRT计划明显高于5F-IMRT和6F-IMRT，差异具有统计学意义（P<0.05），Hybrid-IMRT和4F-IMRT计划之间统计差异不明显（P>0.05）；4种计划心脏的V30、V40差异无统计学意义，Dmean方面，Hybrid-IMRT和4F-IMRT计划明显低于5F-IMRT和6F-IMRT，差异具有统计学意义（P<0.05）；4种计划脊髓的Dmax之间的差异无统计学意义；在甲状腺的Dmean方面，4F-IMRT不如其它3种计划，有统计学差异（P<0.05）；4种计划的机器跳数平均值，Hybrid-IMRT<5F-IMRT<4F-IMRT<6F-IMRT。 结论：Hybrid-IMRT明显改善靶区剂量分布，不会增加周围正常组织的照射剂量，能够通过剂量验证，可在临床推广。
Abstract:
 Abstract: Objective To compare the dose distribution in 4 different plans for the modified radical mastectomy of breast cancer for selecting an optimal treatment strategy with a high target coverage, good homogeneity, better conformity index and less doses to the normal tissues. Methods A total of 16 patients with breast cancer after radical mastectomy were randomly selected, and 4 different treatment plans, namely 4-field (4F), 5-field (5F), 6-field (6F) and hybrid intensity-modulated radiotherapy (IMRT), were designed for each patient. The doses of target areas and organs-at-risk were compared among 4 different treatment plans. Results The conformity index of Hybrid-IMRT, 5F-IMRT and 6F-IMRT was better than that of 4F-IMRT, with statistical differences (P<0.05), and no statistical differences were found in conformity index among Hybrid-IMRT, 5F-IMRT and 6F-IMRT (P>0.05). The homogeneity index of 4F-IMRT, 5F-IMRT, 6F-IMRT and Hybrid-IMRT was 0.22, 0.22, 0.21 and 0.16, respectively, without statistical differences (P>0.05). Hybrid-IMRT and 4F-IMRT were superior to 5F-IMRT and 6F-IMRT in the V5 of ipsilateral lung, and the V20 of ipsilateral lung in Hybrid-IMRT plan were better than that in the other plans (P<0.05). The V30 of ipsilateral lung was significantly lower in Hybrid-IMRT than in 4F-IMRT and 6F-IMRT (P<0.05), but there was no significant difference among other treatment plans (P>0.05). The Dmean of ipsilateral lung in Hybrid-IMRT was significantly higher than 5F-IMRT and 6F-IMRT, with statistical differences (P<0.05), and there was no statistical difference between Hybrid-IMRT and 4F-IMRT plans (P>0.05). No significant differences were found among 4 plans in the V30 and V40 of heart. The Dmean of heart in Hybrid-IMRT and 4F-IMRT was lower than that in 5F-IMRT and 6F-IMRT, with statistical differences (P<0.05). No significant differences were found in the Dmax of the spinal cord among 4 plans. 4F-IMRT was inferior to the other 3 plans in the Dmean of thyroid, with statistical differences (P<0.05). The monitor unit was found to be highest in 6F-IMRT, followed by 4F-IMRT, 5F-IMRT and Hybrid-IMRT. Conclusion Hybrid-IMRT plan which can remarkably improve the dose distribution of target areas, without increasing the radiation dose of organs-at-risk should be further promoted in clinic.

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备注/Memo

备注/Memo:
 【收稿日期】2018-06-12
【作者简介】王磊，物理师，E-mail: 15212465292@126.com
【通信作者】倪昕晔，E-mail: nxy2000@aliyun.com
更新日期/Last Update: 2018-11-22