摘要
目的：比较乳腺癌保乳术后瘤床调强同步推量和瘤床电子线补量放疗剂量学特点,探讨不同瘤床补量方式对全乳、心脏和肺脏受照射体积及剂量的影响。方法：选择10例接受乳腺癌保乳手术Tis-2NoMo早期乳腺癌患者,在术腔放置银夹标记,将银夹所标记的范围外扩1.5-2.0cm定义为瘤床靶区(CTVTb),全乳腺定义为临床靶区(CTV),利用三维适形治疗计划系统(TPS)为每例患者设计瘤床调强同步推量计划(CTVTb处方剂量为2.15Gy×28次,CTV处方剂量为1.81Gy×28次)和瘤床电子线补量计划(CTV处方剂量为2.0Gy×25次,后续局部瘤床电子线补量放疗,剂量为2.0Gy×5次,共2.0Gy×25次+2.0Gy×5次)用剂量体积直方图(DVH)评价靶区剂量均匀度,适形度和正常组织如肺脏,心脏和对侧乳腺所受剂量以及体积。结果：瘤床调强同步推量和瘤床电子线补量计划中瘤床靶区适形性和均匀性差异有统计学意义(P=0.019),全乳腺靶区适形性和均匀性均无统计学意义；肺脏受到≥20Gy剂量照射时的体积V20差异有统计学意义(P=0.001),但肺脏受到≥平均剂量照射时的体积差异无统计学意义；心脏受到≥30Gy剂量照射时的体积V30和心脏受到≥平均剂量照射时的体积差异均无统计学意义；对侧乳腺最大照射剂量和平均照射剂量均无统计学意义。结论：瘤床调强同步推量放疗在瘤床靶区适形度和均匀性方面优于瘤床电子线补量放疗,在正常组织照射体积上相差不明显,但瘤床调强同步推量放疗使受到≥20 Gy剂量照射时的肺脏体积减少。
Objective:To compare the target coverage and normal tissue dose with the simultaneously integrated boost (SIB)and the sequential boost(SBT) technique in early stage breast cancer. Methods:Ten patients with breast cancer treated by conserving breast operation were selected to study, the region marked by silver clips with extended margin of 1.5～2.0cm was defined as gross target volume (CTVTb) and the whole breast was delineated as the clinical target volume (CTV). The breast and boost planning target volumes (CTV and CTV-n,s) were treated simultaneously (i.e., for breast and boost target volumes received 1.81 Gyx28 and 2.15 Gyx28 dose respectively). Dose-volume histograms of the CTV and CTVTbS and organs at risk with the SIB technique were compared with those for the sequential boost technique,2.0 Gy×25+2.0Gyx5。Results: There were not significant difference for dose uniformity and conformality for clinical target volume (CTV),but CTVTb were different between the plannings with SIB and the sequential boost technique(P=0.019). There were not significant difference for the volumes of the ipsilateral lung received equal or more than the mean dose between different planning, but the volume of the lung received>20 Gy in sequential boost planning was significantly higher than that in SIB planning(P=0.001). There were not significant difference for the volumes of the heart received≥30 Gy and equal or more than mean dose in two planning.Conclusions:There is not significant difference for most of the dosimetric parameters in simultaneously integrated boost (SIB)and the sequential boost planning, but the volume of the ipsilateral lung received≥20 Gy in sequential boost planning was significantly higher than that in SIB planning and uniformity and conformality for gross target volume (CTVTb) in SIB superior to in sequential boost planning. The SIB technique is proposed for standard use in breast-conserving radiotherapy because of its dose-limiting capabilities, easy implementation, reduced number of treatment fractions.
引文
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