三维适形调强放疗在乳腺癌根治术中的应用

Application of three-dimensional conformal intensity modulated radiation therapy in radical mastectomy

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.