不同硅胶补偿方式对乳腺癌根治术后调强放射治疗计划剂量学差异分析

牛瑞军; 祁月潇; 陶娜; 郭晴; 魏玺仪; 高力英; 陶发利; 刘婷婷; 成坚强; 魏世鸿

doi:10.11889/j.1000-3436.2022-0083

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不同硅胶补偿方式对乳腺癌根治术后调强放射治疗计划剂量学差异分析

辐射生物学与医学 | 更新时间：2023-06-21

- 不同硅胶补偿方式对乳腺癌根治术后调强放射治疗计划剂量学差异分析
- Dosimetric difference analysis of various bolus regimens in post-mastectomy intensity modulated radiotherapy
- 辐射研究与辐射工艺学报 2023年41卷第3期页码：30307
- 作者机构：
  
  1.甘肃省肿瘤医院兰州 730050
- 作者简介：
  
  牛瑞军，男，1990年1月出生，2013年毕业于南华大学核技术专业，现甘肃省肿瘤医院放疗科医学物理师，从事放射治疗医学物理工作，工程师，E-mail: niuruijungs@163.com
  高力英，主任医师，E-mail: lygaolanzhou@163.com
  魏世鸿，主任医师，E-mail: weishihong100@163.com
- 基金信息：
  
  中华国际医学交流基金会肿瘤精准放疗星火计划(2019-N-11-17);甘肃省卫生行业科研计划项目(GSWSKY2021-052;GSWSKY2022-18;GSWSKY2022-23)
- DOI：10.11889/j.1000-3436.2022-0083
  中图分类号：
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牛瑞军, 祁月潇, 陶娜, 等. 不同硅胶补偿方式对乳腺癌根治术后调强放射治疗计划剂量学差异分析[J]. 辐射研究与辐射工艺学报, 2023,41(3):030307.

NIU Ruijun, QI Yuexiao, TAO Na, et al. Dosimetric difference analysis of various bolus regimens in post-mastectomy intensity modulated radiotherapy[J]. Journal of Radiation Research and Radiation Processing, 2023,41(3):030307.
牛瑞军, 祁月潇, 陶娜, 等. 不同硅胶补偿方式对乳腺癌根治术后调强放射治疗计划剂量学差异分析[J]. 辐射研究与辐射工艺学报, 2023,41(3):030307. DOI： 10.11889/j.1000-3436.2022-0083.

NIU Ruijun, QI Yuexiao, TAO Na, et al. Dosimetric difference analysis of various bolus regimens in post-mastectomy intensity modulated radiotherapy[J]. Journal of Radiation Research and Radiation Processing, 2023,41(3):030307. DOI： 10.11889/j.1000-3436.2022-0083.

摘要

分析不同硅胶补偿方式对乳腺癌根治术后调强放射治疗计划剂量学的影响；应用Oncentra 4.1放射治疗计划系统对38例乳腺癌根治术后患者设计三组放射治疗计划，分别为全程垫5 mm（5 mm_all）、半程垫5 mm（5 mm_half）、半程垫10 mm（10 mm_half）硅胶计划，处方剂量为50 Gy/25 次（2 Gy/次），其中半程计划前15次垫硅胶，后10次不垫硅胶，三组计划设置相同的照射野及目标函数，采用逆向调强进行优化，比较靶区、皮肤及危及器官的剂量学差异，正常组织并发症概率（Normal tissue complication probability NTCP）差异；5 mm_all计划所得CTV的,D,2,、,D,50,、,V,90,、,V,95,、,V,115,均优于其他两组所得且,D,50,、,V,90,有显著的统计学差异（,p<,0.05）；PTV的,D,2,、,D,50,、,D,95,、,D,98,、,D,max,、,V,90,、,V,95,、,V,115,、均匀性指数（HI）及适形度指数（CI）均优于其他两组所得，且,D,50,、,D,95,、,D,98,、,V,90,、,V,95,及HI均有显著的统计学差异（,p<,0.05）；5 mm_all所得食管的,V,45,、心脏的,V,30,、,V,40,、,D,max,，肱骨头的,V,50,、,D,max,、,D,mean,，左肺的,V,20,、,V,30,、,D,max,，甲状腺的,D,max,、,D,mean,，气管的,D,mean,均小于其他组所得，但无显著的统计学差异，5 mm_all所得皮肤的,V,40,、,V,45,、,V,50,、,D,mean,均优于其他组所得，且均有显著的统计学差异（,p<,0.05），高剂量区,V,55,及热点,D,max,均低于其他组计划所得，三组计划总的机器调数（MU）有显著的统计学差异（,p<,0.05）且5 mm_all组总MU最低；5 mm_all组计划NTCP略优于其他组且有显著的统计学差异（,p<,0.05）；在乳腺癌根治术后放射治疗计划设计中，全程垫5 mm硅胶能提高皮肤及靶区的剂量，提高靶区的均匀性指数和适形度指数，减少靶区及皮肤的高剂量区和热点，降低危及器官的受量，而且大幅度地减小治疗总MU减轻加速器负荷，缩短了治疗时间；同时，通过生物学模型的计算可知降低NTCP。

Abstract

The study aimed to analyze and compare dosimetric differences with various thicknesses and frequencies of bolus in post-mastectomy intensity-modulated radiotherapy. Based on the Oncentra4.1 treatment planning system, Thirty-eight post-mastectomy patients were selected randomly between 2017 and 2021. Three sets of simulated treatment planning with 5_mm all, 5_mm half, and 10_mm half virtual boluses were formed. A total prescribed dose of 50 Gy regimen was delivered in 25 fractions over 5 weeks, in which half-time bolus was used for 15 out of 25 fractions. The dosimetric parameters of target areas, skin, and organs at risk were compared. Furthermore, normal tissue complication probability (NTCP) was evaluated for the skin. Regarding the ,D,2,D,50,V,90,V,95, and ,V,115, of the clinical target volume, the 5_mm all bolus group was prominently better than other groups, and the ,D,50, and ,V,90, of the clinical target volumes were statistically significant (,p,<, 0.05). Regarding the ,D,2,D,50,D,95,D,98,D,max,V,90,V,95,V,115, homogeneity index (HI), and conformity index of the planning target volume, the 5_mm thick bolus group was prominently better than other groups, and the ,D,50,D,95,D,98,V,90,V,95, and HI of the clinical target volumes were statistically significant (,p,<, 0.05). For organs at risk, there was no statistical significance for the three planning groups, but the 5_mm all bolus group was prominently better than other groups in the ,V,45, of the esophagus,V,30,V,40, and ,D,max, of the heart,V,50,D,max, and ,D,mean, of the humerus head,V,20,V,30, and ,D,max, of the left lung,D,max, and ,D,mean, of the thyroid, and ,D,mean, of the trachea. Calculated with the 5_mm all bolus, the mean dose,V,40,V,45, and ,V,50, for the skin structure, were all higher than other bolus regimens, while the dose maxima (Skin,max, and ,V,55,) were all lower than others. Regarding the skin radiobiological evaluation, the NTCP of the 5_mm all bolus group was prominently better than other groups and was statistically significant (,p,<, 0.05). Besides, the monitor unit of 5_mm all bolus regimen was the minimum compared with other groups and was statistically significant (,p,<, 0.05). Therefore, the 5_mm all bolus group can not only improve the dose but also reduce the hot dose of skin and target volume, as well as reduce the NTCP. Our study provides a clinical reference in the delivery of post-mastectomy radiotherapy.

关键词

乳腺癌根治术调强放射治疗硅胶剂量学差异分析

Keywords

BreastPost-mastectomy intensity modulated radiotherapyBolusDosimetric difference analysis

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硅胶产生的空腔对乳腺癌根治术后调强放射治疗的剂量学影响