早期乳腺癌保乳术后全乳放疗中瘤床体积变化的CT评价

目的 用重复定位CT评价早期乳腺癌保乳术后放疗中瘤床体积变化规律,分析不同CT上进行瘤床加量计划的剂量学差异.方法 2008-2009年共收集早期乳腺癌保乳术后放疗患者16例,放疗均采用全乳放疗和瘤床加量.患者均接受了3次CT扫描,分别为放疗前(CT1,常规全乳放疗计划CT)、放疗中(CT2)、瘤床加量前(CT3).在3次CT上勾画瘤床.在CT1和CT3上进行三维适形瘤床加量计划并分析剂量体积直方图.结果 CT1、CT2、CT3瘤床平均体积分别为49.5、25.6、22.2 cm3(F=5.63,P=0.007),CT1的＞CT2(q=0.03,P=0.010)和CT3的(q=0.01,P=0.004),CT3与CT2的相似(q=1.00,P=0.333).CT3总体积平均下降43.4%,其中下降＞20%的占88%(14例)、＞50%的占38%(6例).CT1、CT3上患侧乳腺内接受100%处方剂量的平均体积分别为183.5、144.5 cm3(t=3.06,P=0.008).结论 早期乳腺癌保乳术后放疗患者放疗中瘤床体积以放疗后的早期变化显著,在瘤床加量前重新CT扫描进行三维适形瘤床加量计划是合理的.

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