三维适形调强放疗在乳腺癌根治术中的应用
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摘要
目的对三维适形调强放疗在乳腺癌患者改良根治术后的疗效和剂量学进行观察和研究。方法选取2016年2月-2017年2月我院收治的行改良根治术的乳腺癌患者90例,随机分为两组,对照组应用三维适形放疗(3D-CRT),研究组应用三维适形调强放疗(IMRT),对比两组患者辐射剂量以及不良反应发生情况。结果 IMRT同3D-CRT靶区剂量百分比无明显区别(P>0.05),IMRT的V105%、V110%、V115%显著低于3D-CRT(P<0.05),同时IMRT的HI显著低于(P<0.05);同3D-CRT比较而言,IMRT可以有效减少患侧肺、心脏、肝脏以及对侧乳腺射剂量(P<0.05);IMRT治疗患者肝炎、放射性肺损伤、骨髓抑制、胸骨后疼痛以及消化障碍等不良反应发生情况显著低于3D-CRT计划(P<0.05)。结论乳腺癌根治术患者应用IMRT以及3D-CRT的靶区覆盖率都较为理想,但是MIRT在剂量均匀性以及靶区适形度方面更为理想,同时能够降低患者不良反应发生风险,临床上应当进一步推广应用。
Objective To investigate the efficacy and dosimetry of three-dimensional conformal intensity modulated radiation therapy(RT) in patients with modified radical mastectomy for breast cancer after observation and research.Methods 90 patients with breast cancer who underwent modified radical mastectomy in our hospital from February 2016 to February 2017 were randomly divided into two groups, the control group received three-dimensional conformal radiotherapy(3 D-CRT), the researchgroup were treated with three-dimensional conformal radiotherapy(IMRT).The radiation dose and adverse reactions of the two groups were compared.Results There was no significant difference between IMRT and 3 D-CRT target dose percentage(P>0.05), IMRT V105%, V110%, V115% were significantly lower than those of 3 D-CRT(P<0.05), while IMRT HI was significantly lower than that of 3 D-CRT(P<0.05); compared with 3 D-CRT, IMRT can effectively reduce the homolateral lung, heart, liver and contralateral breast dose(P<0.05); the adverse reactions of IMRT treatment in patients with hepatitis, radiation-induced lung injury, bone marrow transplantation, retrosternal pain and digestive disorders incidence were significantly lower than those of 3 D-CRT(P<0.05). Conclusion The coverage are ideal for patients with application of IMRT and 3 D-CRT in the target area of breast cancer, but MIRT is more ideal in dose homogeneity and target area conformal, and can reduce the risk of adverse reactions of patients.It should be further popularized and applied in clinic.
Objective To investigate the efficacy and dosimetry of three-dimensional conformal intensity modulated radiation therapy(RT) in patients with modified radical mastectomy for breast cancer after observation and research.Methods 90 patients with breast cancer who underwent modified radical mastectomy in our hospital from February 2016 to February 2017 were randomly divided into two groups, the control group received three-dimensional conformal radiotherapy(3 D-CRT), the researchgroup were treated with three-dimensional conformal radiotherapy(IMRT).The radiation dose and adverse reactions of the two groups were compared.Results There was no significant difference between IMRT and 3 D-CRT target dose percentage(P>0.05), IMRT V105%, V110%, V115% were significantly lower than those of 3 D-CRT(P<0.05), while IMRT HI was significantly lower than that of 3 D-CRT(P<0.05); compared with 3 D-CRT, IMRT can effectively reduce the homolateral lung, heart, liver and contralateral breast dose(P<0.05); the adverse reactions of IMRT treatment in patients with hepatitis, radiation-induced lung injury, bone marrow transplantation, retrosternal pain and digestive disorders incidence were significantly lower than those of 3 D-CRT(P<0.05). Conclusion The coverage are ideal for patients with application of IMRT and 3 D-CRT in the target area of breast cancer, but MIRT is more ideal in dose homogeneity and target area conformal, and can reduce the risk of adverse reactions of patients.It should be further popularized and applied in clinic.
引文
[1] 李继恩,王旭东,姜在鹏,等.替吉奥口服联合三维适形放疗治疗三阴性乳腺癌效果观察[J].山东医药,2016,56(18):45-47.
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[11] 马长春,李东升,伍方财,等.临床肿瘤靶区位移对左侧乳腺癌改良根治术后调强适形放疗的剂量学影响[J].实用医学杂志,2015,31(11):1801-1803.
[12] Onimaru R,Hida K,Takeda N,et al.Palliative radiotherapy for thoracic spine metastases:Dosimetric advantage of three-dimensional conformal plans[J].Oncology Letters,2015,10(1):497-501.
[13] 刘凌湘,张超,邹国荣.乳腺癌改良根治术后逆向与混合调强放疗剂量学比较[J].中国医学物理学杂志,2015,32(5):742-746.
[14] 周亭芳,邱波,付挺,等.乳腺癌改良根治术后调强放疗致放射性肺损伤的剂量学研究[J].广东医学,2015,36(22):3488-3490.
[15] 王春宇,王铁君,毛铁铸,等.角度变化对乳腺癌术后电子线放疗剂量分布影响研究[J].中国辐射卫生,2016,25(1):11-14.
[2] Shimizuguchi T,Nihei K,Okano T,et al.A comparison of clinical outcomes between three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for prostate cancer[J].International Journal of Clinical Oncology,2017,22(2):373-379.
[3] 任春旺,邓大平.全数字化钼靶X射线对乳腺癌的诊断价值[J].中国辐射卫生,2015,24(2):180-182.
[4] 刘铁斌,宁智超,田平艳.腺癌保乳术后调强放疗与三维适形放疗的疗效比较[J].癌症进展,2017,15(3):321-324.
[5] Kosztyla R,Pierce G,Ploquin N,et al.Poster-21:Verification of monitor unit calculations for breast field-in-field three-dimensional conformal radiotherapy plans[J].Medical Physics,2016,43(8):4940-4941.
[6] 吴剑,钟日奎,刘卓星.乳腺癌术后调强放射治疗的研究[J].临床和实验医学杂志,2016,15(13):1302-1306.
[7] 刘广琥,余浩,汤洁.乳腺钼靶数字摄影技术在乳腺占位性病变中的应用价值[J].中国辐射卫生,2016,25(5):627-629.
[8] 童琴,伍海彪,陈政颂,等.乳腺癌改良根治术后3种放疗技术的剂量学研究[J].实用医学杂志,2015,31(18):3016-3018.
[9] Kumabe A,Fukuhara N,Utsunomiya T,et al.Three-dimensional conformal arc radiotherapy using a C-arm linear accelerator with a computed tomography on-rail system for prostate cancer:clinical outcomes[J].Radiation Oncology,2015,10:208.
[10] 苏建淳,胡学锋,卢秋霞,等.左侧乳腺癌保乳术后调强放疗与常规放疗靶区内剂量均匀性心肺照射剂量和体积的差异分析[J].山西医药杂志,2017,46(14):1714-1716.
[11] 马长春,李东升,伍方财,等.临床肿瘤靶区位移对左侧乳腺癌改良根治术后调强适形放疗的剂量学影响[J].实用医学杂志,2015,31(11):1801-1803.
[12] Onimaru R,Hida K,Takeda N,et al.Palliative radiotherapy for thoracic spine metastases:Dosimetric advantage of three-dimensional conformal plans[J].Oncology Letters,2015,10(1):497-501.
[13] 刘凌湘,张超,邹国荣.乳腺癌改良根治术后逆向与混合调强放疗剂量学比较[J].中国医学物理学杂志,2015,32(5):742-746.
[14] 周亭芳,邱波,付挺,等.乳腺癌改良根治术后调强放疗致放射性肺损伤的剂量学研究[J].广东医学,2015,36(22):3488-3490.
[15] 王春宇,王铁君,毛铁铸,等.角度变化对乳腺癌术后电子线放疗剂量分布影响研究[J].中国辐射卫生,2016,25(1):11-14.