野中野调强放疗在左乳腺癌改良根治术后胸壁放疗的剂量学研究

目的:研究采用野中野调强放疗(FIF-IMRT)进行左乳腺癌改良根治术后胸壁放疗的剂量学特点。方法:回顾性分析2014年9月至2019年8月以来行左乳腺癌改良根治术后予胸壁及锁骨区放疗的77例患者资料。患者均接受胸壁及锁骨区行整体化IMRT,胸壁行FIF-IMRT及锁骨区行IMRT这两种治疗方案,采集并比较靶区相关剂量参数、适形度指数、均匀性指数,肺、心脏及右侧乳腺的剂量体积参数的差异。结果:两种治疗方案均达到放疗计划剂量学要求。两种治疗方案的靶区均匀性指数和适形度指数、PTV-Dmax、PTV-Dmean、PTV-V105%,左肺V5、V10、V20、V30、Dmean,右肺V30,全肺V30以及心脏Dmean相比较,均无统计学意义(P>0.05),而PTV-Dmin、PTV-V95%、PTV-V110%、右肺Dmean、V5、V10、V20,全肺Dmean、V5、V20,心脏V5、V30、V40,右侧乳腺Dmean相比较,均有统计学意义(P<0.05)。结论:乳腺癌根治术后胸壁采取FIF-IMRT结合锁骨区IMRT的治疗方案在降低正常组织的剂量照射和受照体积方面优势明显。

Field in field intensity-modulated radiotherapy to the chest wall following modified radicalmastectomy for left-sided breast cancer: a dosimetric study

Objective To study the dosimetric characteristics of field in field intensity-modulated radiotherapy(FIF-IMRT) in chest wall after modified radical mastectomy.Methods Totally 77 patients from September 2014 to August 2019 treated with radiotherapy in chest wall and supraclavicular area after modified radical mastectomy,were include in the retrospective.All of them having integrated volume IMRT plan(IMRT group) and fractionated radiotherapy which FIF-IMRT plan were designed in chest wall and IMRT plan in supraclavicular area(FIF-IMRT group).Comparative endpoints were planning target volume (PTV) dose,CI,HI,doses to lung、heart and Right breast of both group.Results The radiation treatment was successfully completed conducted for all patients.In the comparison of both group,there is no significant differences in HICI V5、V10、V20、V30、Dmean of left lung；maximum dose of PTV；PTV V105% (P>0.05).and minimum dose of PTV、 PTV-V95%、PTV-V110% Dmean、V5、V10、V20 of right lung ；mean doses and V5、V20 of both lung V5、V30、V40 of heart and Dmean of right breast were statistically significant(P<0.05).Conclusions Fractionated radiotherapy in chest wall and supraclavicular area has obvious advantages in reducing dose and volume of normal tissues after modified radical mastectomy.