[1]张磊,李浦,杨一威,等. 双侧乳腺癌同步放疗设计中多射野中心及固定钨门技术的应用[J].中国医学物理学杂志,2019,36(4):373-378.[doi:DOI:10.3969/j.issn.1005-202X.2019.04.001]
　ZHANG Lei,LI Pu,YANG Yiwei,et al. Application of double-isocenter and fixed-jaw technology in radiotherapy for bilateral breast cancer[J].Chinese Journal of Medical Physics,2019,36(4):373-378.[doi:DOI:10.3969/j.issn.1005-202X.2019.04.001]
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 双侧乳腺癌同步放疗设计中多射野中心及固定钨门技术的应用()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
36卷
期数:
2019年第4期
页码:
373-378
栏目:
医学放射物理
出版日期:
2019-04-25

文章信息/Info

Title:
 Application of double-isocenter and fixed-jaw technology in radiotherapy for bilateral breast cancer
文章编号:
1005-202X（2019）04-0373-06
作者:
 张磊; 李浦; 杨一威; 翁邓胡; 方敏; 邵凯南; 郑士明
 浙江省肿瘤医院放射物理室/浙江省肿瘤放射治疗重点实验室， 浙江 杭州310022
Author(s):
 ZHANG Lei;  LI Pu;  YANG Yiwei;  WENG Denghu;  FANG Min;  SHAO Kainan;  ZHENG Shiming
 Key Laboratory of Tumor Radiotherapy, Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou 310022, China
关键词:
 ; 双侧乳腺癌; 双射野中心; 固定钨门技术; 容积旋转调强; 静态调强放射治疗
Keywords:
 ; Keywords: bilateral breast cancer;  double-isocenter;  fixed-jaw technology;  volumetric modulated arc therapy;  static intensity-modulated radiotherapy
分类号:
R811.1；R737.9；R312
DOI:
DOI:10.3969/j.issn.1005-202X.2019.04.001
文献标志码:
A
摘要:
 【摘要】目的：拟利用双射野中心及固定钨门限定射野范围方式分别设计双侧乳腺癌的容积弧形旋转调强及三维静态调强放疗计划，并对两者放射治疗计划的结果进行评价，分析此放疗技术在临床治疗的可行性。方法：选取8例确诊且进行放疗的双侧乳腺癌患者进行回顾性研究。利用RayStation v4.5系统，基于Trilogy加速器参数分别设计两种固定射野的调强计划：双射野中心容积旋转调强（D-VMAT）、双射野中心三维静态调强（D-sIMRT）。肿瘤计划靶区（PTV）处方剂量为5 000 cGy/25 f，要求双侧乳腺靶区PTV-L、PTV-R均至少95%以上的靶区体积达到处方剂量，利用剂量体积直方图及计划系统的Clincal goal工具比较两者剂量分布、靶区剂量的均匀性及适形性和心脏、双肺、肝脏、脊髓等重要危及器官的剂量差异。结果：两种双中心固定射野的调强计划均可以满足双侧乳腺肿瘤靶区的处方剂量，同时重要器官的剂量满足临床放疗医师限定标准。D-VMAT计划在剂量均匀性指数（HI）及靶区适形度指数（CI）方面均优于D-sIMRT计划（P<0.05）。两者在心脏V20、肝脏V5和Dmean以及脊髓Dmax保护上并无明显差异。D-sIMRT与D-VMAT计划在全肺的剂量上相比较，后者可以显著降低全肺区域的剂量受量，V5（47.9%±4.6% vs 42.2%±3.9%, P=0.001）、V20（22.9%±6.7% vs 17.5%±4.3%, P=0.021）、V30（15.7%±5.8% vs 11.7%±3.6%, P=0.031）、Dmean[（1 222.5±246.7） cGy vs （1 009.5±161.3） cGy, P=0.009］，且能更好降低心脏的平均剂量（P<0.05）；机器跳数MU为（1 177±311 vs 908±130, P=0.036）。结论：双射野中心及限定射野钨门技术的调强计划均可以满足双侧乳腺癌的临床放疗实施，同时D-VMAT计划可给予靶区更好的剂量均匀性及适形性，降低心脏和肺放疗损伤剂量以及提高治疗效率。
Abstract:
 Abstract: Objective To apply double-isocenter and fixed-jaw technology for the design of volumetric modulated arc therapy (VMAT) and static intensity-modulated radiotherapy (sIMRT) plans for bilateral breast cancer and evaluate the dosimetric results of the two plans, so as to discuss the feasibility of double-isocenter and fixed-jaw technology in radiotherapy for bilateral breast cancer. Methods The clinical data of 8 patients with confirmed bilateral breast cancer were retrospective analyzed. Based on Trilogy accelerator parameters, 2 fixed-field radiotherapy plans, namely double-isocenter VMAT (D-VMAT) and double-isocenter sIMRT (D-sIMRT), were designed on RayStation v4.5 system. The planning target volume (PTV) was irradiated with a prescribed dose of 5 000 cGy in 25 fractions. At least 95% of bilateral breast target areas, namely PTV-L and PTV-R, were covered with prescribed dose. The dose-volume histogram and the Clincal goal tool of treatment planning system were used to compare the target dose distribution, the conformity index and homogeneity index of PTV, and the dosimetric characteristics of organs-at-risk, such as heart, lungs, liver and spinal cord. Results Both of two radiotherapy plans satisfied the treatment criteria. The bilateral breast target areas were irradiated by prescribed dose and the doses of organs-at-risk were within the limits determined by the clinical physicists. D-VMAT was superior to D-sIMRT in the homogeneity index and conformity index of PTV (P<0.05). No statistical differences were found in the V20 of heart, the V5 and Dmean of liver and the Dmax of spinal cord between two plans. However, the V5, V20, V30 of lungs and mean lung dose were significantly reduced in D-VMAT as compared with D-sIMRT [47.9%±4.6% vs 42.2%±3.9%, 22.9%±6.7% vs 17.5%±4.3%, 15.7%±5.8% vs 11.7%±3.6%, (1 222.5±246.7) cGy vs (1 009.5±161.3) cGy; P=0.001, 0.0021, 0.031, 0.009］. Moreover, compared with D-sIMRT, D-VMAT decreased the mean dose of heart (P<0.05) and increased monitor units (1 177±311 vs 908±130, P=0.036). Conclusion The radiotherapy plan using double-isocenter and fixed-jaw technology meets the requirements of radiotherapy for bilateral breast cancer. Meanwhile, D-VMAT not only achieves better homogeneity index and conformity index of target areas, but also reduces the radiation-induced injuries to heart and lung and increase the efficiency of treatment.

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备注/Memo

备注/Memo:
 【收稿日期】2018-12-09
【基金项目】国家重点研发计划（2017YFC0113201）；国家自然科学基金（81703018）
【作者简介】张磊，硕士研究生，研究方向：医学物理，E-mail: zhanglei@zjcc.org.cn
更新日期/Last Update: 2019-04-22