[1]刘玉平,张震,王瑜,等.胸壁补偿膜厚度及患者体型特征对乳腺癌调强放疗摆位误差和剂量学的影响[J].中国医学物理学杂志,2024,41(6):678-682.[doi:DOI:10.3969/j.issn.1005-202X.2024.06.004]
　LIU Yuping,ZHANG Zhen,WANG Yu,et al.Effects of chest wall compensation film thickness and patients body characteristics on setup errors and dosimetry in intensity-modulated radiotherapy for breast cancer[J].Chinese Journal of Medical Physics,2024,41(6):678-682.[doi:DOI:10.3969/j.issn.1005-202X.2024.06.004]
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胸壁补偿膜厚度及患者体型特征对乳腺癌调强放疗摆位误差和剂量学的影响()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
41卷
期数:
2024年第6期
页码:
678-682
栏目:
医学放射物理
出版日期:
2024-06-25

文章信息/Info

Title:
Effects of chest wall compensation film thickness and patients body characteristics on setup errors and dosimetry in intensity-modulated radiotherapy for breast cancer
文章编号:
1005-202X（2024）06-0678-05
作者:
刘玉平; 张震; 王瑜; 常娟娟; 王光明
阜阳市肿瘤医院放疗科三病区， 安徽 阜阳 236048
Author(s):
LIU Yuping;  ZHANG Zhen;  WANG Yu;  CHANG Juanjuan;  WANG Guangming
Third Ward, Department of Radiotherapy, Fuyang Cancer Hospital, Fuyang 236048, China
关键词:
乳腺癌; 胸壁; 补偿膜厚度; 体型特征; 调强放疗; 摆位误差; 放疗剂量
Keywords:
Keywords: breast cancer chest wall compensation film thickness body characteristics intensity-modulated radiotherapy setup error radiation dose
分类号:
R811.1
DOI:
DOI:10.3969/j.issn.1005-202X.2024.06.004
文献标志码:
A
摘要:
目的：探讨胸壁补偿膜厚度及患者体型特征对乳腺癌患者手术后接受调强放疗治疗的摆位误差及放疗剂量的影响。方法：采用前瞻性研究方法，选取2021年1月至2023年6月阜阳市肿瘤医院肿瘤放疗中心治疗的103例乳腺癌患者，对患者进行锥形束CT检查，分析患者的体质量指数（BMI）、肿瘤位置、胸围、患侧乳腺体积对其摆位误差的影响，分析不同厚度的补偿膜对患者靶区、肺部、心脏、脊髓的放射剂量的影响。结果：不同BMI、不同患侧分布的乳腺癌患者在左右方向上的摆位误差无统计学意义（P>0.05）；胸围≥89.0 cm、患侧乳腺体积≥650 cm3患者的左右方向摆位误差大于胸围<89.0 cm、患侧乳腺体积<650 cm3患者（P<0.05）。不同患侧分布的乳腺癌患者在上下方向上的摆位误差无统计学意义（P>0.05）；BMI≥23.1 kg/m?胸围≥89.0 cm、患侧乳腺体积≥650 cm3患者的上下方向摆位误差大于BMI<23.1 kg/m?胸围<89.0 cm、患侧乳腺体积<650 cm3患者（P<0.05）；不同BMI水平、不同胸围、不同乳腺体积、不同患侧分布的乳腺癌患者在前后方向上的摆位误差无统计学意义（P>0.05）。左侧乳腺癌病灶患者采用0.5 cm补偿膜和1.0 cm补偿膜的放射治疗计划靶区（PTV）D95%、PTV靶区D5%、左侧肺部V20%、心脏V30%、心脏平均剂量（Dmean）、脊髓最大剂量（Dmax）、机器跳数（MU）、均匀性指数（HI）测定值比较，差异无统计学意义（P>0.05）；采用0.5 cm补偿膜患者的适形度指数（CI）值低于采用1.0 cm补偿膜的乳腺癌患者（P<0.05），右侧乳腺癌病灶患者采用0.5 cm补偿膜和1.0 cm补偿膜的PTV靶区D95%、PTV靶区D5%、右侧肺部V20%、脊髓Dmax、MU、CI、HI测定值比较，差异无统计学意义（P>0.05）。结论：对于乳腺癌调强放疗患者，BMI、胸围、患侧乳腺体积均与摆位误差有关，采用0.5 cm和采用1.0 cm胸壁补偿膜均可以用于术后放疗，对放疗剂量和加速器跳数影响不大。
Abstract:
Abstract: Objective To investigate the effects of the thickness of the chest wall compensation film and the patients body characteristics on the setup errors and radiation dose of breast cancer patients receiving intensity-modulated radiotherapy following surgery. Methods A total of 103 patients with breast cancer who were treated in the Tumor Radiotherapy Center of Fuyang Cancer Hospital from January 2021 to June 2023 were selected for a prospective study. All patients received cone-beam CT scan. The effects of body mass index (BMI), tumor location, chest circumference, and the affected breast volume on the setup errors were analyzed and the effects of different compensation film thicknesses on the radiation doses to the planning target volume (PTV), lung, heart, and spinal cord were explored. Results The left-right setup errors didnt differ significantly in breast cancer patients with different BMI and affected sides (P>0.05) but the patients with chest circumference ≥ 89.0 cm and affected breast volume ≥ 650 cm3 had greater left-right setup errors than the other patients (chest circumference < 89.0 cm and affected breast volume < 650 cm3) (P<0.05). The difference in the superior-inferior setup errors was trivial in breast cancer patients with different affected sides (P>0.05), but the superior-inferior setup errors were greater in patients with BMI ≥ 23.1 kg/m? chest circumference ≥ 89.0 cm, and breast volume on the affected side ≥ 650 cm3 than the others (BMI < 23.1 kg/m? chest circumference < 89.0 cm, and breast volume on the affected side < 650 cm3) (P<0.05). There was no significant difference in the anterior-posterior setup errors in breast cancer patients with different BMI, chest circumferences, breast volumes, and affected sides (P>0.05). For left-sided breast cancer, the measured values of D95% and D5% of PTV, V20% of left lung, V30% and Dmean of heart, Dmax of spinal cord, MU, and HI in patients with 0.5 and 1.0 cm compensation films were close (P>0.05) while lower CI was found in patients with 0.5 cm compensation film than those with 1.0 cm compensation film (P<0.05). For right-sided breast cancer, the measured values of D95% and D5% of PTV, V20% of right lung, Dmax of spinal cord, MU, CI, and HI didnt differ significantly between patients using 0.5 and 1.0 cm compensation films (P>0.05). Conclusion The BMI, chest circumference, and breast volume on the affected side in breast cancer patients undergoing intensity-modulated radiotherapy are all associated with the setup errors. Both 0.5 and 1.0 cm chest wall compensation films can be used for postoperative radiotherapy, which has little effect on the dosimetry and accelerator MU.

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备注/Memo

备注/Memo:
【收稿日期】2023-11-21 【基金项目】安徽省自然科学基金（2020085MH251） 【作者简介】刘玉平，副主任医师，研究方向：肿瘤放射治疗，E-mail: 13955804107@163.com 【通信作者】王光明，主任医师，研究方向：肿瘤放射治疗，E-mail: wgmahfy@126.com
更新日期/Last Update: 2024-06-25