基于内缘切线野的调强放疗与容积弧形调强放疗在左侧乳腺癌保乳术后放疗中的剂量学研究

国际肿瘤学杂志››2024,Vol. 51››Issue (7): 441-447.doi:10.3760/cma.j.cn371439-20231204-00072

基于内缘切线野的调强放疗与容积弧形调强放疗在左侧乳腺癌保乳术后放疗中的剂量学研究

赵彪¹, 蒲琴¹, 袁美芳¹, 马立双¹, 李瀚¹, 杨毅¹, 孙朝细²()

¹北京大学肿瘤医院云南医院云南省肿瘤医院昆明医科大学第三附属医院放射治疗科，昆明 650118
²北京大学肿瘤医院云南医院云南省肿瘤医院昆明医科大学第三附属医院重症医学科，昆明 650118

收稿日期:2023-12-04修回日期:2024-04-02出版日期:2024-07-08发布日期:2024-08-14
通讯作者:孙朝细，Email：sunchaoxi1201@126.com
基金资助:
国家自然科学基金(81760423)

Dosimetric study of intensity-modulated radiotherapy and volumetric intensity modulated arc therapy based on the inner edge tangent field for radiotherapy after breast-conserving surgery of left-sided breast cancer

Zhao Biao¹, Pu Qin¹, Yuan Meifang¹, Ma Lishuang¹, Li Han¹, Yang Yi¹, Sun Chaoxi²()

¹Department of Radiotherapy， Peking University Cancer Hospital Yunnan， Yunnan Cancer Hospital， Third Affiliated Hospital of Kunming Medical University， Kunming 650118， China
²Department of Critical Care Medicine， Peking University Cancer Hospital Yunnan， Yunnan Cancer Hospital， Third Affiliated Hospital of Kunming Medical University， Kunming 650118， China

Received:2023-12-04Revised:2024-04-02Online:2024-07-08Published:2024-08-14
Contact:Sun Chaoxi， Email：sunchaoxi1201@126.com
Supported by:
National Natural Science Foundation of China(81760423)

摘要/Abstract

摘要：

目的探究左侧乳腺癌保乳术后基于内缘切线野（IETF）的调强放疗（IMRT）与容积弧形调强放疗（VMAT）的剂量学差异。方法选取2022年6月至2023年6月收治于云南省肿瘤医院放射治疗科的35例左侧乳腺癌保乳术后行IMRT患者的定位CT和靶区危及器官（OAR）等资料，针对同一患者分别设计基于IETF的IMRT和VMAT两种放疗计划，IETF-IMRT和IETF-VMAT；对两种放疗计划的靶区和OAR剂量及计划执行时间进行比较。结果靶区剂量：IETF-IMRT和IETF-VMAT两种放疗计划靶区的D_98%分别为（47.92±0.51）、（48.21±0.33）Gy，D_50%分别为（52.04±0.22）、（51.91±0.26）Gy，D_2%分别为（53.93±0.36）、（53.62±0.41）Gy，适形指数分别为0.84±0.03、0.87±0.02，均匀性指数分别为0.12±0.01、0.10±0.01，差异均有统计学意义（t=-3.87，P<0.001；t=3.53，P=0.001；t=5.30，P<0.001；t=-13.60，P<0.001；t=6.24，P<0.001）。OAR剂量：IETF-IMRT和IETF-VMAT两种放疗计划左肺V₅分别为（31.91±6.28）%、（33.99±6.31）%，V₂₀分别为（11.71±2.06）%、（9.73±2.12）%，差异均有统计学意义（t=-4.18，P<0.001；t=12.40，P<0.001）；右肺V₅分别为（0.11±0.08）%、（7.13±3.12）%，D_mean分别为（1.05±0.12）、（2.71±0.27）Gy，差异均有统计学意义（t=-33.62，P<0.001；t=-13.30，P<0.001）；脊髓D_2%分别为（1.08±0.11）、（4.83±1.40）Gy，差异有统计学意义（t=-15.99，P<0.001）。左肺D_mean分别为（7.45±1.08）、（7.37±1.03）Gy，心脏D_mean分别为（4.21±0.96）、（4.41±0.48）Gy，右侧乳腺D_mean分别为（3.74±1.52）、（3.48±1.11）Gy，差异均无统计学意义（t=1.16，P=0.253；t=-1.76，P=0.088；t=1.41，P=0.169）。计划执行时间：IETF-IMRT和IETF-VMAT两种放疗计划执行时间分别为（10.73±1.21）、（2.18±0.17）min，差异有统计学意义（t=44.71，P<0.001）。结论IETF-IMRT和IETF-VMAT均能满足临床要求，但两种技术各有特点。靶区适形性和均匀性方面，IETF-VMAT略优；两种计划的OAR剂量均显著低于乳腺癌术后放疗剂量限值，其中，IETF-IMRT计划的左肺V₅，右肺V₅、D_mean和脊髓D_2%略低，IETF-VMAT计划的左肺V₂₀略低。IETF-VMAT较IETF-IMRT显著缩短了计划执行时间，可极大地降低患者体位变化引起的剂量偏差，明显提高患者放疗体验感和舒适度；综合考虑，左侧乳腺癌保乳术后放疗IETF-VMAT较IETF-IMRT更具优势。

关键词:乳腺肿瘤,内缘切线野,乳腺癌保乳术后,调强放疗,容积弧形调强放疗,剂量学

Abstract:

ObjectiveTo explore the dosimetry difference between intensity-modulated radiotherapy （IMRT） and volumetric intensity modulated arc therapy （VMAT） based on the inner edge tangent field （IETF） after left-sided breast conserving surgery.MethodsThe localization CT and target organ at risk （OAR） data of 35 patients with left-sided breast cancer treated with IMRT after breast conserving surgery at Department of Radiotherapy in Yunnan Cancer Hospital from June 2022 to June 2023 were selected. The IETF-IMRT and the IETF-VMAT plans were designed for the same patient based on IETF， the dosimetry differences of target areas and OAR， as well as the planned execution time were compared between the two groups.ResultsDosimetry of target areas： for IETF-IMRT and IETF-VMAT， the D_98%of the planning target volume were （47.92±0.51） and （48.21±0.33） Gy， respectively， while the D_50%were （52.04±0.22） and （51.91±0.26） Gy， respectively， and the D_2%were （53.93±0.36） and （53.62±0.41） Gy， respectively， the conformity index were 0.84±0.03 and 0.87±0.02， respectively， while the homogeneity index were 0.12±0.01 and 0.10±0.01， respectively， with statistically significant differences （t=-3.87，P<0.001；t=3.53，P=0.001；t=5.30，P<0.001；t=-13.60，P<0.001；t=6.24，P<0.001）. Dosimetry of OAR： for IETF-IMRT and IETF-VMAT， the left lung V₅were （31.91±6.28）% and （33.99±6.31）%， respectively， and the V₂₀were （11.71±2.06）% and （9.73±2.12）%， respectively， with statistically significant differences （t=-4.18，P<0.001；t=12.40，P<0.001）. The right lung V₅were （0.11±0.08）% and （7.13±3.12）%， respectively， and the D_meanwere （1.05±0.12） and （2.71±0.27） Gy， respectively， with statistically significant differences （t=-33.62，P<0.001；t=-13.30，P<0.001）. The spinal cord D_2%were （1.08±0.11） and （4.83±1.40） Gy， respectively， with a statistically significant difference （t=-15.99，P<0.001）. The left lung D_meanwere （7.45±1.08） and （7.37±1.03） Gy， the heart D_meanwere （4.21±0.96） and （4.41±0.48） Gy， and the right-sided breast D_meanwere （3.74±1.52） and （3.48±1.11） Gy， respectively， with no statistically significant difference （t=1.16，P=0.253；t=-1.76，P=0.088；t=1.41，P=0.169）. Planned execution time： the execution time of IETF-IMRT and IETF-VMAT was （10.73±1.21） and （2.18±0.17） min， respectively， with a statistically significant difference （t=44.71，P<0.001）.ConclusionBoth IETF-IMRT and IETF-VMAT can meet clinical requirements， however the two techniques have their own characteristics. IETF-VMAT has better conformity and homogeneity of target region. The planned OAR dosimetry in both plans are significantly lower than the dose limit of postoperative radiotherapy for breast cancer， among which the left lung V₅， the right lung V₅， D_meanand spinal cord D_2%of IETF-IMRT are slightly lower， the left lung V₂₀of IETF-VMAT is slightly lower. IETF-VMAT significantly reduces the planned execution time compared with IETF-IMRT， thus can greatly reduce the dose deviation caused by patient position change， and significantly improve patients experience and comfort of radiotherapy. Taken together， IETF-VMAT has advantages over IETF-IMRT in radiotherapy after breast conserving surgery of left-sided breast cancer.

Key words:Breast neoplasms,Inner edge tangent field,Breast conserving surgery for breast cancer,Intensity-modulated radiotherapy,Volumetric intensity modulated arc therapy,Dosimetry

赵彪, 蒲琴, 袁美芳, 马立双, 李瀚, 杨毅, 孙朝细. 基于内缘切线野的调强放疗与容积弧形调强放疗在左侧乳腺癌保乳术后放疗中的剂量学研究[J]. 国际肿瘤学杂志, 2024, 51(7): 441-447.

Zhao Biao, Pu Qin, Yuan Meifang, Ma Lishuang, Li Han, Yang Yi, Sun Chaoxi. Dosimetric study of intensity-modulated radiotherapy and volumetric intensity modulated arc therapy based on the inner edge tangent field for radiotherapy after breast-conserving surgery of left-sided breast cancer[J]. Journal of International Oncology, 2024, 51(7): 441-447.

图/表4

图1

图2

参数	IETF-IMRT	IETF-VMAT	t值	P值
D_98%（Gy）	47.92±0.51	48.21±0.33	-3.87	<0.001
D_50%（Gy）	52.04±0.22	51.91±0.26	3.53	0.001
D_2%（Gy）	53.93±0.36	53.62±0.41	5.30	<0.001
CI	0.84±0.03	0.87±0.02	-13.60	<0.001
HI	0.12±0.01	0.10±0.01	6.24	<0.001

表1

表2

35例左侧乳腺癌保乳术后患者两种放疗计划OAR剂量学参数比较（$\bar{x}\pm s$）"

参数	IETF-IMRT	IETF-VMAT	t值	P值
左肺
V₅（%）	31.91±6.28	33.99±6.31	-4.18	<0.001
V₂₀（%）	11.71±2.06	9.73±2.12	12.40	<0.001
D_mean（Gy）	7.45±1.08	7.37±1.03	1.16	0.253
心脏
D_mean（Gy）	4.21±0.96	4.41±0.48	-1.76	0.088
右肺
V₅（%）	0.11±0.08	7.13±3.12	-33.62	<0.001
D_mean（Gy）	1.05±0.12	2.71±0.27	-13.30	<0.001
右侧乳腺
D_mean（Gy）	3.74±1.52	3.48±1.11	1.41	0.169
脊髓
D_2%（Gy）	1.08±0.11	4.83±1.40	-15.99	<0.001

表2

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