Auto-planning在乳腺癌根治术后A-VMAT中的优化性能评估及临床应用

目的对基于Auto-planning(AP)技术的乳腺癌根治术后自动容积旋转调强放疗计划(Automated Volumetric Modulated Arc Therapy,A-VMAT)的优化性能与临床应用价值进行综合评估。方法选择24例乳腺癌根治术后患者,采用Pinnacle39.10计划系统手动设计容积旋转调强计划(Manual-VMAT,M-VMAT),采集其剂量体积直方图参数作为AP的优化参数以实现A-VMAT计划,分别比较两组计划靶区和危及器官的各项参数,评估AP技术的优化性能。结果左、右两侧乳腺癌A-VMAT计划的CI及HI结果均优于M-VMAT计划(t=5.53、-4.42;t=3.94、5.61;P<0.05)。健侧肺:A-VMAT计划V₅及以上的体积参数均低于M-VMAT计划,且仅V₅差异有统计学意义(t=3.64,2.32;P<0.05);而患侧肺仅V₄₀低于M-VMAT计划。心脏:左、右两侧乳腺癌A-VMAT计划的V₂高于M-VMAT计划;而右侧乳腺癌V₅以上的各参数则呈现相反趋势,仅V₂₀、V₃₀的差异有统计学意义(P<0.05)。A-VMAT计划的平均MUs值均小于M-VMAT计划,但无统计学差异。结论对于乳腺癌根治术后患者,与M-VMAT计划相比,A-VMAT计划具有更佳的靶区剂量分布及更低的正常组织受量。

Evaluation of Optimization Performance and Clinical Application of Auto-planning in A-VMAT for Breast Cancer after Radical Mastectomy

Objective To complete a comprehensive evaluation of the optimized performance and clinical application value of automatic volumetric modulated arc therapy(A-VMAT)for breast cancer after radical mastectomy based on Auto-planning technology.Methods A total of 24 patients with breast cancer after radical mastectomy were selected,and Pinnacle39.10 plan system was used to manually design volumetric modulated arc therapy(M-VMAT),the parameters of dose volume histogram were collected as the optimization parameters of auto-planning to realize the A-VMAT,and then compare the parameters of target and organ at risk in the two plans,to evaluate the optimization performance of auto-planning technology.Results The CI and HI results of the A-VMAT plan on the left and right sides were better than those of the M-VMAT plan(t=5.53,-4.42;t=3.94,5.61;P<0.05).Uninfected lung:The volume parameters of V₅ and above in A-VMAT plan were lower than those in M-VMAT plan,and only V₅ had statistical differences(t=3.64,2.32;P<0.05);for the affected lung tissue,only V₄₀ was lower than M-VMAT plan.Heart:V₂ in A-VMAT plan of left and right breast cancer patients were higher than those of M-VMAT plan;however,all parameters above V₅ in right breast cancer patients showed an opposite trend,and only V₂₀ and V₃₀ showed statistically significant differences(P<0.05).The average MUs of the A-VMAT plan was less than that of the M-VMAT plan,but there is no statistical difference.Conclusion Compared with M-VMAT plan,A-VMAT plan has better target dose distribution and lower normal tissue dose for patients with breast cancer after radical mastectomy.