多叶准直器遮挡技术对乳腺癌保乳术后混合调强放疗患者心肺受量、细胞免疫功能及心肺功能的影响

Effect of MLC shielding technique on cardiorespiratory load, cellular immune function and cardiopulmonary function in IMRT patients after breast-conserving surgery

目的探讨多叶准直器(MLC)遮挡技术对乳腺癌保乳术后混合调强放疗(IMRT)患者心肺受量、细胞免疫功能及心肺功能的影响。方法选取2018年2月至2020年6月就诊于江苏省如皋市人民医院的62例乳腺癌保乳术后患者作为研究对象,根据随机数字表法分为研究组和对照组,各31例。两组均应用四维电子计算机断层扫描(4DCT)于三维电子计算机断层扫描(3DCT)图像上明确靶区,对照组制定H_IMRT计划,研究组制定加入MLC遮挡技术的治疗计划(HSH_IMRT)。靶区处方剂量50Gy,25次完成。对比两组治疗前、治疗后(25次放疗全部完成后)细胞免疫功能指标(CD3+、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+))、心肺功能指标[左室射血分数(LVEF)、短轴缩短率(FS)、第1秒用力呼气容积(FEV_(1))/用力肺活量(FVC)]水平。结果研究组治疗计划结果与剂量验证结果的全心脏D_(mean)、V_(40)、V_(3)0、V_(20)、V_(10)及患侧肺D_(mean)、V_(20)均低于对照组(P<0.05);研究组治疗后血清CD3+、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平均高于对照组(P<0.05);研究组治疗后LVEF、FS、FEV_(1)/FVC水平均高于对照组(P<0.05)。结论将MLC遮挡技术应用于乳腺癌保乳术后行H_IMRT的患者,可在满足临床需求的前提下减少心肺受量,减轻细胞免疫功能及心肺功能损伤。

Objective To investigate the effect of multi-lobe collimator(MLC)shielding technique on cardiopulmonary load,cellular immune function and cardiopulmonary function in patients with mixed intensity-modulated radiotherapy(IMRT)after breast-conserving breast cancer surgery.Methods A total of 62 patients with breast cancer after breast conserving surgery in Rugao People′s Hospital of Jiangsu Province from February 2018 to June 2020 were selected as the research objects,and they were divided into study group and control group according to the random number table method,with 31 cases in each.Four-dimensional computed tomography(4DCT)was used to define the target area on 3DCT images in both groups.The control group formulated the H_IMRT plan,and the study group formulated the MLC shielding technique treatment plan(HSH_IMRT).The prescribed dose of the target area is 50Gy,and 25 times are completed.Comparison of cellular immune function indexes(CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+)),cardiopulmonary function indexes[left ventricular ejection fraction(LVEF),short axis shortening rate(FS),forced expiratory volume in 1 second(FEV_(1))/forced vital capacity(FVC)]before treatment and after treatment(after all 25 radiotherapy sessions)between the two groups.Results The whole heart D_(mean),V_(40),V_(30),V_(20),V_(10) and the affected lung D_(mean) and V_(20) of the treatment plan and dose verification results of the study group were lower than those of the control group(P<0.05).The levels of serum CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+)in the study group after treatment were higher than those in the control group(P<0.05);the levels of LVEF,FS,FEV 1/FVC in the study group were higher than those in the control group after treatment(P<0.05).Conclusions The application of MLC shielding technique in breast cancer patients undergoing H_IMRT after breast conserving surgery can reduce cardiopulmonary load,cellular immune function and cardiopulmonary function damage under the premise of meeting clinical needs.