螺旋断层固定野调强放疗技术在乳腺癌改良根治术后胸壁放疗中的应用效果

Effect of spiral tomography fixed field intensity radiotherapy on chest wall radiotherapy after modified radical mastectomy for breast cancer

目的探讨螺旋断层固定野调强放疗技术在乳腺癌改良根治术后胸壁放疗中的应用.方法对本院2015年6月~2018年5月收治的58例乳腺癌改良根治术后患者(左乳32例,右乳26例)进行回顾性分析,在VarianECLIPSE系统中分别设计适形固定野调强放疗(IMRT)、容积弧形调强(RapidAre)、螺旋断层调强放疗(HT)及螺旋断层固定野调强放疗(TD),比较4种计划的靶区适形度(CI)、剂量均匀性(HI)和危及器官的剂量分布、机器跳数(MU)的差异.结果 RapidAre技术的CI指标与HT技术的HI指标相较于其他技术差异有统计学意义(P<0.05);健侧肺中TD技术相较于其他技术差异有统计学意义(P<0.05);TD技术中脊髓的平均值及最大值相较于其他技术差异有统计学意义(P<0.05).结论 TD技术对心脏、患侧肺与总肺的低剂量区以及脊髓的受量控制中表现出绝对的优势,有效降低了患者在放疗时身体正常组织的受照剂量.

Objective To investigate the application of spiral-fixed fixed-field intensity-modulated radiotherapy in chest wall radiotherapy after modified radical mastectomy. Methods 58 patients with breast cancer modified radical mastectomy(32 cases of left breast and 26 cases of right breast) admitted to our hospital from June 2015 to May 2018 was retrospectively analyzed. In the Varian ECLIPSE system, conformal fixed field intensity modulated radiotherapy (IMRT), volumetric arc intensity (RapidAre), spiral tonal intensity modulated radiotherapy (HT), and spiral tomography fixed field intensity radiotherapy (TD) were designed. The difference in target contours (CI), dose uniformity (HI) and dose distribution at risk of organ, machine hop count (MU) of the 4 kinds of plans were compared. Results The CI index of RapidAre technique and the HI index of HT technique were statistically different from other techniques(P<0.05). The difference between TD technique and other techniques in healthy lung was statistically significant(P<0.05). The mean and maximum values of spinal cord in TD technique were statistically significant compared with other techniques(P<0.05). Conclusion TD technology has an absolute advantage in the low-dose area of the heart, the affected lung and the total lung, and the control of the spinal cord, which effectively reduces the dose of the normal tissue of the patient during radiotherapy.