Meta分析保乳术后三维适形与调强技术剂量学比较

崔芹玲; 孙岩; 钟文; 郭根燕; 陈延治; 赵玉霞

doi:10.11889/j.1000-3436.2016.rrj.34.030201

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Meta分析保乳术后三维适形与调强技术剂量学比较

辐射生物学与医学 | 更新时间：2021-12-10

- Meta分析保乳术后三维适形与调强技术剂量学比较
- Meta-analysis of dosimetric comparision between three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for breast cancer with conserving surgery
- 辐射研究与辐射工艺学报 2016年34卷第3期页码：17-23
- 作者机构：
  
  1.中国医科大学附属第四医院放疗科沈阳 110032
- 作者简介：
  
  [ "崔芹玲,女,1987年2月出生,2014年毕业于河北大学,现为中国医科大学肿瘤放射治疗学专业在读硕士研究生,E-mail:cuiql0313@163.com", "CUI Qinling (female) was born in February 1987 and graduated from Hebei University in 2014. Now she is a master candidate in Department of Radiation Oncology of Cancer Center, Fourth Affiliated Hospital of China Medical University. E-mail:cuiql0313@163.com" ]
  赵玉霞,博士,教授,E-mail:zyx_yd@163.comPh.D. ZHAO Yuxia, professor, E-mail: zyx_yd@163.com
- 基金信息：
  
  辽宁省医院改革重点临床科室诊疗能力建设项目资助(NCCC-B08-2014)
- DOI：10.11889/j.1000-3436.2016.rrj.34.030201
  中图分类号：
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崔芹玲, 孙岩, 钟文, 等. Meta分析保乳术后三维适形与调强技术剂量学比较[J]. 辐射研究与辐射工艺学报, 2016,34(3):17-23.

Qinling CUI, Yan SUN, Wen ZHONG, et al. Meta-analysis of dosimetric comparision between three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for breast cancer with conserving surgery[J]. Journal of Radiation Research and Radiation Proces, 2016,34(3):17-23.
崔芹玲, 孙岩, 钟文, 等. Meta分析保乳术后三维适形与调强技术剂量学比较[J]. 辐射研究与辐射工艺学报, 2016,34(3):17-23. DOI： 10.11889/j.1000-3436.2016.rrj.34.030201.

Qinling CUI, Yan SUN, Wen ZHONG, et al. Meta-analysis of dosimetric comparision between three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for breast cancer with conserving surgery[J]. Journal of Radiation Research and Radiation Proces, 2016,34(3):17-23. DOI： 10.11889/j.1000-3436.2016.rrj.34.030201.

摘要

探讨调强放疗(Intensity-modulated radiotherapy, IMRT)在早期乳腺癌放疗中的剂量学优势,以期得到有价值的循证医学证据以指导临床应用。使用计算机检索PubMed、EMbase、Sciencedirect、中国知网、维普、万方数据库,同时辅助其它检索,收集关于早期乳腺癌保乳术后三维适形技术(Three-dimensionalconformal radiotherapy, 3D-CRT)与IMRT剂量学比较的文献,应用RevMan 5.2.0软件对满足条件的15项(263例患者)数据进行Meta分析。结果表明,与3D-CRT相比,IMRT显著降低了患侧肺,V,20,(,p,=0.004)、,V,30,(,p,=0.008)、,V,40,(,p,=0.0008)、,D,max, (,p,=0.001)和心脏,V,30,(,p,=0.002)、,V,40,(,p,=0.00001);降低了计划靶区,D,max,(,p,<,0.00001);对,V,95,(,p,=0.05)、,V,105,(,p,<,0.0001)、,V,110,(,p,<,0.00001)覆盖更好;均匀指数HI及适形指数CI也较好,p,=0.02;但却增加了患侧肺,V,5,(,p,=0.0005)、,V,10,(,p,=0.05),心脏,V,5,(,p,<,0.0001)、,V,10,(,p,=0.0007),健侧肺,V,5,(,p,=0.002)、,D,men, (,p,=0.0004)和健侧乳腺,V,3,(,p,=0.0006)。计划靶区V100、,D,mean,、,D,min,、患侧肺,D,mean,、心脏,V,20,、,D,max,、,D,mean,、健侧乳腺,D,mean,IMRT与3D-CRT相似,差异不显著。结果提示,在早期乳腺癌保乳术后放疗中,IMRT对靶区覆盖好且剂量分布均匀,并可以减少高剂量照射区正常组织的剂量,保护正常组织,但却增加了低剂量照射区组织的剂量。

Abstract

The aim was to evaluate the dosimetry superiority of IMRT (Intensity-modulated radiotherapy) in early-stage breast cancer with conserving surgery and provide more valuable evidences to the clinical researches. Clinical trials of dosimetric comparision between 3D-CRT and IMRT for early-stage breast cancer with conserving surgery were obtained from PubMed, EMbase, Sciencedirect, Wei pu, CNKI (China national knowledge Infrastructure), and Wanfang databases, which were evaluated and analyzed with the Cochrane Collaboration's RevMan 5.2.0 software. Fifteen samples were included. Compared with 3D-CRT plans, IMRT plans had a lower ipsilateral lung ,V,20, (,p,=0.004),V,30, (,p,=0.008),V,40, (,p,=0.000 8),D,max, (,p,=0.001) and heart ,V,30, (,p,=0.002),V,40, (,p,<,0.000 01), while had a higher ipsilateral lung ,V,5, (,p,=0.000 5),V,10, (,p,=0.05) and heart ,V,5, (,p,<,0.000 1),V,10, (,p,=0.000 7). IMRT plans provided a significantly better coverage of the PTV ,V,95, (,p,=0.05),V,105, (,p,<,0.000 1),V,110, (,p,<,0.000 01) and maximal dose (,p,<,0.000 01). IMRT plans had a better dose homogeneity index and conformity index than 3D-CRT plans, both with ,p,=0.02, but had a higher contralateral lung ,V,5, (,p,=0.002),D,max, (,p,=0.000 4) and contralateral breast ,V,3, (,p,=0.000 6). There was no significant difference between IMRT and 3D-CRT plans for ,V,100, mean and minimal doses of PTV, ipsilateral lung mean dose, heart ,V,20, maximum, mean dose, and contralateral mean dose, all ,p,>,0.05. Compared with 3D-CRT plans, IMRT plans had the dosimetry superiority for early-stage breast cancer with significantly better coverage and dose homogeneity of planning target volume while maintaining lower doses to high risk organs.

关键词

早期乳腺癌放射治疗三维适形放射治疗调强放射治疗Meta 分析

Keywords

Breast cancerRadiotherapyThree-dimensional conformal radiotherapy (3D-CRT)Intensitymodulated radiotherapy (IMRT)Meta-analysis

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