乳腺癌根治术后2种照射模式的剂量学比较研究

doi:10.11958/20252154

摘要/Abstract

摘要：

目的比较容积调强弧形放疗（VMAT）与固定野调强放疗（IMRT）在乳腺癌根治术后胸壁及锁骨上下区照射中的剂量学差异。方法纳入100例乳腺癌根治术后拟行放疗患者作为研究对象，采用随机数字表法分为VMAT组和IMRT组，每组50例，比较2组的靶区剂量参数、危及器官受照剂量、机器跳数（MU）及治疗时间。结果 VMAT组与IMRT组的V₉₅、V₁₁₀比较，差异无统计学意义（P>0.05）；VMAT组的D_2%低于IMRT组，D_98%、D_50%高于IMRT组（P<0.05）；VMAT组的靶区均匀性、靶区适形度优于IMRT组（P<0.05）；VMAT组与IMRT组的心脏平均剂量（D_mean）、同侧肺V₅、V₁₀比较，差异无统计学意义（P>0.05）；VMAT组的心脏V₂₀、V₃₀，对侧肺D_mean，脊髓最大剂量（D_max），对侧乳腺D_mean，同侧肺D_mean、V₂₀、V₃₀，平均MU低于IMRT组；治疗时间短于IMRT组（P<0.05）。结论在乳腺癌根治术后胸壁及锁骨上下区的照射治疗中，VMAT技术相较于IMRT在靶区均匀性、靶区适形度、危及器官受照剂量方面表现出更优的剂量学特性，治疗效率高。

关键词: 乳腺肿瘤, 放射疗法，调强适形, 放射治疗剂量, 容积调强弧形治疗, 固定野调强放疗

Abstract:

Objective To compare the dosimetric differences between volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) in the irradiation of chest wall and upper and lower clavicle regions after radical mastectomy for breast cancer. Methods A total of 100 patients who were scheduled to receive radiotherapy after radical mastectomy were included and selected as research subjects. Patients were divided into the VMAT group and the IMRT group by random number table method, with 50 cases in each group. The target dose parameters, exposure dose of organs at risk, monitor unit (MU) and treatment time were compared between the two groups. Results There were no statistical differences in V₉₅ and V₁₁₀ between the VMAT group and the IMRT group (P>0.05). The D_2% in the VMAT group was lower than that of the IMRT group, while D_98% and D_50% were higher in the VMAT group than those in the IMRT group (P<0.05). Target area uniformity and target area conformity were better in the VMAT group than those in the IMRT group (P<0.05). There were no significant differences in mean cardiac dose (D_mean) and ipsilateral lung V₅ and V₁₀ between the VMAT group and the IMRT group (P>0.05). The heart V₂₀ and V₃₀, contralateral lung D_mean, maximum spinal cord dose (D_max), contralateral breast D_mean, ipsilateral lung D_mean, V₂₀, V₃₀ and mean MU were lower in the VMAT group than those in the IMRT group, and the treatment time was shorter than that in the IMRT group (P<0.05). Conclusion In the irradiation treatment of chest wall and upper and lower clavicle regions after radical mastectomy, VMAT demonstrates superior dosimetric characteristics and higher treatment efficiency compared with IMRT, particularly in terms of target area uniformity, target area conformity and exposure doses to organs at risk.

Key words: breast neoplasms, radiotherapy, intensity-modulated, radiotherapy dosage, volumetric modulated arc therapy, intensity modulated radiation therapy

中图分类号:

R737.9，R816.42

图/表 4

参考文献 14

[1]	KOLÁŘOVÁ I, MELICHAR B, SIRÁK I, et al. The role of adjuvant radiotherapy in the treatment of breast cancer[J]. Curr Oncol, 2024, 31(3):1207-1220. doi:10.3390/curroncol31030090.
[2]	MIÉVILLE F A, PITTELOUD N, ACHARD V, et al. Post-mastectomy radiotherapy:impact of bolus thickness and irradiation technique on skin dose[J]. Z Med Phys, 2024, 34(4):542-554. doi:10.1016/j.zemedi.2023.03.004.
[3]	AEBI S, KARLSSON P, WAPNIR I L. Locally advanced breast cancer[J]. Breast, 2022, 62(Suppl 1):S58-S62. doi:10.1016/j.breast.2021.12.011.
[4]	PRASUN P, KHARADE V, PAL V, et al. Dosimetric comparison of hypofractionated regimen in breast cancer using two different techniques:intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy(VMAT)[J]. Cureus, 2023, 15(4):e38045. doi:10.7759/cureus.38045.
[5]	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2019年版)[J]. 中国癌症杂志, 2019, 29(8):609-679.
	Breast Cancer Committee of Chinese Anti-cancer Association. Guidelines for breast cancer diagnosis and treatment by China Anti-cancer Association (2019 edition)[J]. Chin Oncol, 2019, 29(8):609-679. doi:10.19401/j.cnki.1007-3639.2019.08.009.
[6]	ADENEYE S, AKPOCHAFOR M, ADEDEWE N, et al. A dosimetric comparison of volumetric modulated arc therapy and intensity modulated radiotherapy in patients treated with post-mastectomy radiotherapy[J]. Eur J Breast Health, 2023, 19(1):92-98. doi:10.4274/ejbh.galenos.2022.2022-9-2.
[7]	AZHARUDDIN S K, KUMAR P, S N, et al. Comparison of dosimetric parameters and clinical outcomes in inversely planned intensity-modulated radiotherapy(IMRT) and field-in-field forward planned IMRT for the treatment of breast cancer[J]. Cureus, 2022, 14(7):e26692. doi:10.7759/cureus.26692.
[8]	LIN H, SHENG X, LIU H, et al. Dosimetry of intensity-modulated radiation therapy and volumetric-modulated arc therapy techniques after modified radical mastectomy for breast cancer and hypofractionated intensity-modulated radiotherapy[J]. J Cancer Res Ther, 2023, 19(6):1568-1574. doi:10.4103/jcrt.jcrt_51_23.
[9]	宋鹏, 杨远富, 廖长富. 容积旋转调强放疗治疗鼻咽癌的效果及急性口腔黏膜反应分析[J]. 四川医学, 2024, 45(4):399-404.
	SONG P, YANG Y F, LIAO C F. Analysis of VMAT efficacy and acute oral mucosa response in the treatment of nasopharyngeal carcinoma[J]. Sichuan Med J, 2024, 45(4):399-404. doi:10.16252/j.cnki.issn1004-0501-2024.04.012.
[10]	POOJARI A, SAPRU S, KHURANA R, et al. Whole-breast irradiation with lumpectomy cavity boost and regional nodal irradiation:dosimetric comparison of 3D-CRT using sequential boost and dual partial-arc VMAT using simultaneous integrated boost[J]. Precis Radiat Oncol, 2023, 7(2):118-127. doi:10.1002/pro6.1203.
[11]	BANFILL K, GIULIANI M, AZNAR M, et al. Cardiac toxicity of thoracic radiotherapy:existing evidence and future directions[J]. J Thorac Oncol, 2021, 16(2):216-227. doi:10.1016/j.jtho.2020.11.002.
[12]	MISHRA S S, NANDA S, AHIRWAR M K, et al. Advancing precision in post-mastectomy chest wall radiotherapy:a comparative dosimetric analysis of volumetric-modulated arc therapy(VMAT)and intensity-modulated radiotherapy(IMRT) based on institutional experience[J]. Cureus, 2023, 15(5):e38464. doi:10.7759/cureus.38464.
[13]	张豪, 林权冰, 池周. 乳腺癌改良根治术后放疗诱发放射性肺炎的危险因素分析[J]. 中国妇幼健康研究, 2021, 32(3):395-400.
	ZHANG H, LIN Q B, CHI Z. Analysis of risk factors for radiation pneumonitis after modified radical mastectomy[J]. Chin J Woman Child Health Res, 2021, 32(3):395-400. doi:10.3969/j.issn.1673-5293.2021.03.015.
[14]	曾华驱, 张慧, 吴齐兵. 胸中下段食管癌放疗计划中使用广义等效均匀剂量进行优化的剂量学分析[J]. 中国医疗设备, 2023, 38(12):57-62.
	ZENG H Q, ZHANG H, WU Q B. Dosimetric analysis of optimization using generalized equivalent uniform dose in radiotherapy planning for lower mid-thoracic esophageal cancer[J]. Chin Med Dev, 2023, 38(12):57-62. doi:10.3969/j.issn.1674-1633.2023.12.011.

组别	年龄/岁	病变侧		肿瘤T分期
组别	年龄/岁	左侧	右侧	T3	T4
IMRT组	52.56±9.83	23（46.0）	27（54.0）	23（46.0）	27（54.0）
VMAT组	51.52±11.20	21（42.0）	29（58.0）	22（44.0）	28（56.0）
χ²或t	0.494	0.162		0.040

组别	年龄/岁	病变侧		肿瘤T分期
组别	年龄/岁	左侧	右侧	T3	T4
IMRT组	52.56±9.83	23（46.0）	27（54.0）	23（46.0）	27（54.0）
VMAT组	51.52±11.20	21（42.0）	29（58.0）	22（44.0）	28（56.0）
χ²或t	0.494	0.162		0.040

组别	D_2%/Gy	D_98%/Gy	D_50%/Gy	V₉₅/%
IMRT组	55.23±1.07	45.93±0.96	51.29±0.96	97.97±0.90
VMAT组	54.60±0.85	47.13±1.06	52.22±0.87	98.13±1.01
t	3.268^＊＊	5.959^＊＊	5.079^＊＊	0.828
组别	V₁₁₀/%	HI		CI
IMRT组	1.47±0.47	0.18±0.03		0.79±0.06
VMAT组	1.61±0.44	0.14±0.02		0.85±0.05
t	1.525	7.263^＊＊		5.844^＊＊

组别	D_2%/Gy	D_98%/Gy	D_50%/Gy	V₉₅/%
IMRT组	55.23±1.07	45.93±0.96	51.29±0.96	97.97±0.90
VMAT组	54.60±0.85	47.13±1.06	52.22±0.87	98.13±1.01
t	3.268^＊＊	5.959^＊＊	5.079^＊＊	0.828
组别	V₁₁₀/%	HI		CI
IMRT组	1.47±0.47	0.18±0.03		0.79±0.06
VMAT组	1.61±0.44	0.14±0.02		0.85±0.05
t	1.525	7.263^＊＊		5.844^＊＊

组别		心脏
组别		D_mean/Gy		V₃₀/%		V₂₀/%
IMRT组		7.88±1.74		9.70±2.44		15.52±4.22
VMAT组		7.28±1.35		7.75±1.92		13.04±3.28
t		1.918		4.439^＊＊		3.285^＊＊
组别		对侧肺 D_mean/Gy		脊髓 D_max/Gy		对侧乳腺 D_mean/Gy
IMRT组		3.42±0.84		27.69±4.98		2.93±0.86
VMAT组		2.95±0.62		25.35±3.15		1.81±0.47
t		3.182^＊＊		2.803^＊＊		8.088^＊＊
组别	同侧肺
组别	D_mean/Gy		V₃₀/%	V₂₀/%	V₁₀/%	V₅/%
IMRT组	13.80±1.16		18.08±1.57	23.73±1.87	33.90±23.04	45.10±5.27
VMAT组	12.64±0.88		15.55±1.20	20.55±1.55	33.76±2.12	45.09±3.58
t	5.624^＊＊		9.046^＊＊	9.228^＊＊	0.275	0.020