[1]毕苏艳,任骅,王越男.一种改善乳腺癌锁骨上区与乳腺区域接野处剂量分布的保乳术后放疗计划[J].中国医学物理学杂志,2020,37(9):1095-1100.[doi:10.3969/j.issn.1005-202X.2020.09.003]
　BI Suyan,REN Hua,WANG Yuenan.A radiotherapy plan following breast-conserving surgery for improving the dose distribution atthe junction region between supra-clavicular fossa region and breast region[J].Chinese Journal of Medical Physics,2020,37(9):1095-1100.[doi:10.3969/j.issn.1005-202X.2020.09.003]
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一种改善乳腺癌锁骨上区与乳腺区域接野处剂量分布的保乳术后 放疗计划()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
37
期数:
2020年第9期
页码:
1095-1100
栏目:
医学人工智能
出版日期:
2020-09-25

文章信息/Info

Title:
A radiotherapy plan following breast-conserving surgery for improving the dose distribution at the junction region between supra-clavicular fossa region and breast region
文章编号:
1005-202X（2020）09-1095-06
作者:
毕苏艳; 任骅; 王越男
国家癌症中心/国家癌症研究中心/中国医学科学院肿瘤医院北京协和医学院肿瘤医院深圳医院，广东深圳518116
Author(s):
BI Suyan;  REN Hua;  WANG Yuenan
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital，Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
关键词:
乳腺癌; 调强放疗; 乳腺区域; 锁骨上区域; 剂量学
Keywords:
breast cancer intensity-modulated radiotherapy breast region supra-clavicular fossa region dosimetry
分类号:
R811.1
DOI:
10.3969/j.issn.1005-202X.2020.09.003
文献标志码:
A
摘要:
目的：介绍一种乳腺癌术后放疗计划设计方案，用于乳腺区与锁骨上区同时照射时，改善接野处剂量分布不均匀的 情况。方法：选取10例已完成治疗的乳腺癌病例，均需进行锁骨上区和乳腺区照射。常规设计方案包括锁骨上区设计3 野调强放疗计划和胸壁乳腺区设计混合调强计划。本研究保持常规计划设计方案不变，在乳腺区与锁骨上区的接野处采 用野中野设计方案，通过调节子野的叶片位置，形成剂量跌落梯度。比较两种方案计划的剂量学差异，靶区的剂量学参数 包括计划靶区（PTV）和PTV_J的Dmax、Dmin、均匀性指数（CI）和适形度指数（HI），PTV_J为接野处沿头脚方向2 cm勾画的 PTV的体积。危及器官的剂量学参数包括患侧肺的V5、V20、V30和Dmean，心脏的Dmean，健侧乳腺的V20和Dmean以及脊髓的 Dmax。结果：和常规设计方案相比，改良后设计方案接野处的CI和HI得到明显改善（P<0.05），整体靶区的CI和HI比较无 明显差别（P>0.05），危及器官的剂量学比较无明显差异（P>0.05）。结论：改良的设计方案能在不影响其他结构的剂量分 布情况下明显改善接野处剂量分布，可用于临床乳腺癌放疗。
Abstract:
Objective To introduce a modified radiotherapy plan after breast-conserving surgery for improving the uniformity of dose distribution at the junction region between supra-clavicular fossa (SC) region and breast region. Methods Ten patients who underwent treatment and required both SC irradiation and breast irradiation were selected for the study. Conventional plan included 3-field intensity-modulated radiotherapy (IMRT) on SC region and hybrid IMRT on breast region. The plans of 10 patients were re-planned using the proposed method.With 3-field IMRT on SC region, field-in-field technique was applied on tangential breast fields for creating a dose gradient at the junction region by adjusting the position of mutli-leaf collimator leaves. The dosimetric differences between two plans were compared. The dosimetric indicators of target areas included the Dmax, Dmin, conformity index (CI) and homogeneity index (HI) of PTV and PTV_J. PTV_J was defined as the volume of the junction region, which was 1 cm cranial and 1 cm caudal to the iso-center in PTV. The dosimetric indicators of organs-at-risk included the V5, V20, V30, Dmean of the affected lung, the Dmean of the heart, the V20, Dmean of the contralateral breast and the Dmax of spinal cord. Results The CI and HI of PTV_J in modified plan were superior to those in conventional plan (P<0.05). However, there was no significant difference in the CI and HI of PTV and the dosimetric indicators of organs-at-risk (all P>0.05). Conclusion The modified plan which can improve the dose distribution at the junction region, without affecting the doses of target areas and organs-at-risk, can be applied into the radiotherapy for breast cancer.

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备注/Memo

备注/Memo:
【收稿日期】2020-03-24 【基金项目】中国医学科学院肿瘤医院王绿化教授肿瘤放射治疗团队 （三名工程）（SZSM201612063） 【作者简介】毕苏艳，硕士，放疗物理师，临床工程师（初级），研究方 向：放射治疗物理学，E-mail: 974525146@qq.com 【通信作者】王越男，Email: yuenan.wang@yahoo.com
更新日期/Last Update: 2020-09-25