摘要
目的:比较乳腺癌保乳术后外照射内侧和外侧瘤床两种局部加量方法的剂量学特点,为临床寻求最佳的瘤床加量方法。方法:对16例瘤床偏外侧、22例瘤床偏内侧共计38例乳腺癌保乳术后患者进行治疗计划设计,分别勾画全乳靶区和瘤床靶区。电子线补量计划使用6 MV-X线对全乳进行野中野正向调强设计,处方剂量50 Gy/25 fx/5 W,完成后局部瘤床再使用9 Mev电子线补量使得瘤床总量60 Gy/30 fx/6 W。同步加量计划,使用6 MV-X线对全乳和瘤床设计5～6个照射野的逆向调强计划,处方剂量为全乳靶区50 Gy/25 fx/5 W,瘤床靶区60 Gy/25 fx/5 W。所有患者都进行两套计划设计,并分别比较外侧组和内侧组的剂量学特点,同时观察放疗期间和放疗结束3月内的局部皮肤和放射性肺炎情况。结果:外侧组的同步加量计划的靶区适形性、均匀性和V95%均显著优于电子线补量计划,同侧肺V20、V30小于后者,同侧肺V5、心脏Dmean和对侧肺Dmean大于后者,同侧肺Dmean无统计学差异;内侧组的同步加量计划的靶区适形性优于电子线补量计划,同侧肺V5、心脏Dmean大于后者,同侧肺的V30小于后者,同侧肺V20、Dmean、对侧肺Dmean无统计学差异,全部患者都顺利完成放疗计划,Ⅰ、Ⅱ级放射性皮炎的发生率为29%,未出现严重的局部皮肤破损情况,未发生放射性肺炎。结论:乳腺癌保乳术后瘤床偏外侧的患者进行外照射时,使用同步加量的方法能明显优化靶区剂量,不会增加危及器官的受量,同时可以缩短放疗疗程,瘤床偏内侧的患者两种方法都可以。
Objective： To compare the dosimetric characteristics of two method of increasing the local dose inside and outside the tumor bed for breast cancer radiation after breast-conserving surgery, look after the best method for clinical. Methods： There are 16 cases of tumor bed lateral and 22 cases of tumor bed medial after breast-conserving operation, 38 patients do ra- diotherapy plane, separated drawn the whole breast target area and the tumor bed target area. Electronic filling-quantity planned forward with field-in-field intensity-modulated design of whole breast using 6 MV- X-ray, prescription dose was 50 Gy/25 fx/5 W, after the completion of the local tumor bed and then used the 9Mev electronic filling quantities that the tumor bed totaled 60 Gy/30 fx/6 W. Synchronous dosage plan, using the 6 MV- X-ray of whole breast and tumor bed with 5 - 6 radiation field de- signed inverse IMRT plan, prescription dose for whole breast target 50 Gy/25 fx/5 W, tumor bed target 60 Gy/25 fx/5 W. All patients underwent two sets of program, compared the dosimetric characteristics of the lateral group and the medial group, and observed local skin and radioactive pneumonia situation during radiotherapy and within 3 months. Results： For the lateral group, synchronization dosage plan conformal, uniformity and V950/0 were significantly better than the electronic filling-quantity plan, ipsilateral lung V20, V30 is less than the latter, lung V5, heat Dmean and contralateral lung Dmean is greater than the latter, there was no significant difference in ipsilateral lung Dmean; For the medial group, synchronization dosage plan was conformal thanelectronic filling-quantity plan, ipsilateral lung Vs, heart Dmean is larger than the latter, ipsilateral lung V3o is less than the latter, ip- silateral lung V20, Dmean, contralateral lung Dmean showed no significant difference, all patients completed radiotherapy planning, I , Ⅱ radioactive dermatitis incidence rate was 29%, no local serious skin damage, without the occurrence of radiation pneu- monitis. Conclusions： External irradiation in patients with tumor bed lateral after conservative surgery for breast cancer, using the method of synchronous dosage can significantly optimize dose, not increase the amount of compromised organs, also can shorten the period of radiotherapy, patients with tumor bed medial can use either methods.
出处
《中国医学物理学杂志》
CSCD
2013年第3期4100-4103,共4页
Chinese Journal of Medical Physics
基金
无锡市科技局社会支撑指令性项目(CSE01N1223)
关键词
乳腺癌
放射疗法
瘤床加量
剂量学
breast carcinoma / radiotherapy
tumor bed boost
dosimetry
