3D打印补偿膜在乳腺癌即刻乳房重建术后放疗中的应用

Application of 3D printing compensation film in postoperation radiotherapy of immediate breast reconstruction for breast cancer

目的探讨3D打印补偿膜在乳腺癌即刻乳房重建术后放疗患者中的应用效果。方法选取2021年11月至2022年5月在湖南省肿瘤医院收治的11例女性乳腺癌改良根治术后即刻乳房重建的患者,用同一序列先后对3D打印补偿膜和市售补偿膜覆盖后进行CT定位扫描,勾画空气间隙、靶区及危及器官,采用同一参数分别进行调强放疗(intensity modulated radiation therapy,IMRT)计划设计(3D打印补偿膜为计划A,市售补偿膜为计划B),然后分析两组计划的空气间隙,靶区剂量均匀性指数(relative dose homogeneity index,HI),靶区新适形度指数(new conformity index,nCI),危及器官患侧肺的平均剂量(Dmean)、V5、V20、V30,心脏V30、健侧乳腺Dmean的差异。结果计划A的空气间隙体积小于计划B[(8.029±2.542)cm^(3)vs(20.048±4.372)cm^(3),t=-5.300,P<0.001]。与计划B相比,计划A的HI[(0.134±0.008)%vs(0.161±0.016)%,t=-2.246,P=0.049]、健侧乳腺Dmean[(159.909±17.925)cGy vs(173.364±19.248)cGy,t=-2.343,P=0.041]和患侧肺V20[(25.782±0.876)%vs(26.373±0.836)%,t=-2.334,P=0.042]降低,nCI升高[0.79%(IQR:0.77%~0.83%)vs 0.78%(IQR:0.75%~0.81%),Z=-2.316,P=0.021],而心脏V30和患侧肺Dmean、V5、V30差异无统计学意义(均P>0.05)。结论在乳腺癌即刻乳房重建术后放疗患者中,3D打印补偿膜较市售补偿膜在与皮肤贴合度、靶区剂量分布及均匀性方面均具有优势,在提高表皮剂量的同时降低了危及器官受照剂量,在临床应用中具有一定的潜在价值。

Objective To analyze the efficacy of the 3D printing compensation film in the postoperation radiotherapy for breast cancer patients after immediate breast reconstruction.Methods A total of 11 patients who underwent immediate breast reconstruction after modified radical mastectomy in Hunan Cancer Hospital from November 2021 to May 2022 were selected.The same sequence was used to perform CT positioning scanning after covering the 3D printing compensation film and the commercial compensation film,and the air gap,target area and organs at risk were delineated.Two intensity modulated radiation therapy(IMRT)plans were designed with the same parameters(Plan A:3D printing compensation film;Plan B:commercial compensation film).The differences between the two plans were analyzed with respect to air gap,homogeneity index(HI),new conformity index(nCI),the mean dose(Dmean),V5,V20,V30 of the lung on the affected side lung,the cardiac dose V30 and the healthy side breast Dmean.Results The air gap volume of Plan A was smaller than that of Plan B[(8.029±2.542)cm^(3) vs(20.048±4.372)cm^(3),t=-5.300,P<0.001].Compared with those of Plan B,the HI[(0.134±0.008)%vs(0.161±0.016)%,t=-2.246,P=0.049],the healthy breast Dmean[(159.909±17.925)cGy vs(173.364±19.248)cGy,t=-2.343,P=0.041]and the lung on the affected side lung V20[(25.782±0.876)%vs(26.373±0.836)%,t=-2.334,P=0.042)of Plan A were decreased,and the nCI was increased[0.79%(IQR:0.77%-0.83%)vs 0.78%(IQR:0.75%-0.81%),Z=-2.316,P=0.021],but there was no significant difference in cardiac dose V30,and the affected side lung Dmean,V5 and V30(all P>0.05).Conclusions In patients with immediate breast reconstruction after radiotherapy for breast cancer,the 3D printing compensation film has advantages over the commercial compensation film with respect to fitness to skin,dose distribution and uniformity in the target area,improving the epidermal dose while reducing the dose of exposure to organs at risk,and has certain potential value in clinical application.