| 李栋庆,林涛,于静萍,倪新初,高留刚,彭鸣亚.乳腺癌术后容积调强放疗下移动误差对靶区剂量的影响[J].中华放射医学与防护杂志,2018,38(11):819-823 |
| 乳腺癌术后容积调强放疗下移动误差对靶区剂量的影响 |
| Tolerance range of breast cancer patients with set-up errors after volume modulated radiotherapy |
| 投稿时间：2018-06-10 |
| DOI：10.3760/cma.j.issn.0254-5098.2018.11.004 |
| 中文关键词: 乳腺癌 容积调强放疗 摆位误差 |
| 英文关键词:Breast cancer Volume modulated radiotherap Set-up error |
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| 中文摘要: |
| 目的 通过对乳腺癌术后放疗患者虚拟移动误差，预测实际临床操作中移动误差的宽容范围。方法 回顾性分析了本院近3年来的乳腺癌术后行放疗的患者。根据治疗方法不同抽取10例改良根治术后乳腺癌病例，10例保乳根治术后病例，勾画靶区，制定容积调强放疗计划，移动放疗计划中心点虚拟移动误差，以1 mm步进移动最大至5 mm，重新计算剂量后记录相应数据，记录临床靶区（CTV）的V50、心脏平均量、患侧肺V20，CTV的体积等数据。应用SPSS 19.0软件进行统计分析，重复测量方差分析方法分析移动中心点后靶区实际剂量的变化。直线回归分析方法分析CTV体积与CTV移动中心点后剂量变化的相关关系。结果 虚拟移动误差后在近似乳腺切线方向的轴线方向影响较小，而近似乳腺切线方向的垂直方向影响较大，且在影响较大的垂直轴线上移动超过3 mm 后的CTV（V50）值下降至83.85%，低于对CTV靶区剂量的一般要求。各个方向的移动误差进行统计分析发现，除左乳B方向移动误差所导致的剂量学变化差异无统计学意义（P>0.05）外，其他方向均具有统计学意义（F=34.182、12.877、16.443、9.846、46.829、10.122、57.931，P<0.05）。手术方式（保乳术后与改良根治术后）对靶区移动的影响不大。通过相关性分析发现，乳腺癌患者靶区CTV的体积与左乳B、C及右乳B方向的移动误差所带来的影响具有线性相关（F=5.733、18.496、6.630，P<0.05），其他方向均无线性相关，且无明显规律可循。结论 在乳腺癌术后放疗中，不论左乳还是右乳，需要对垂直于乳腺切面方向的误差尤其注意。当该方向的误差超过3 mm后， CTV明显不足。移动误差对CTV剂量的影响与乳腺癌手术方式无关，与靶区体积大小的相关性无明显规律。 |
| 英文摘要: |
| Objective To predict the tolerance range of set-up errors in clinical practice by predicting the virtual set-up errors of postoperative radiotherapy patients for breast cancer. Methods A retrospective analysis was made of the patients who underwent radiotherapy after breast cancer surgery in recent 3 years. According to different treatment method, 10 cases of breast cancer after modified radical mastectomy and 10 cases after breast conserving radical mastectomy were selected. The target area was delineated, the volume modulated radiation therapy plan was made, the virtual moving error of the center point of the plan was moved, and the maximum moving error was 5 mm by 1 mm step. After recalculating the dose, the corresponding data including the clinical target areas (CT), CTV(V50), average heart volume, V20 of the affected lung and CTV volume were recorded. SPSS 19.0 software was used for statistical analysis, and repeated measurement of variance analysis was used to analyze the changes of the actual dose in the target area after moving the center point. Linear regression analysis method was used to analyze the correlation between the CTV volume and the dose change after the CTV moving midline. Results The virtual set-up error had little influence on the axis direction of the approximate mammary tangent direction, while the vertical direction of the approximate mammary tangent direction had greater influence. After moving more than 3 mm on the vertical axis, the CTV (V50) decreased to below 90%, which was lower than the general requirement for the target area of CTV. Statistical analysis of set-up errors in all directions showed that there was significant difference in dosimetric changes (F=34.182, 12.877, 16.443, 9.846, 46.829, 10.122, 57.931, P<0.05) in all directions except the B direction of left breast set-up errors (P>0.05). Between breast conserving surgery and modified radical mastectomy, there was little effect on target movement. Through correlation analysis, it was found that the volume of CTV in the target area of breast cancer patients was linearly related to the errors caused by the movement of B, C and B directions of left breast and right breast(F=5.733, 18.496, 6.630, P<0.05). Conclusions In postoperative radiotherapy for breast cancer, the errors perpendicular to the section of breast should be paid special attention to whether left or right breast. When the error of this direction exceeds 3 mm, CTV is obviously less than V50 below 83.85%. The effect of set-up error on the dose of CTV was not related to the operation mode of breast cancer and there was no obvious correlation with the volume of the target area. |
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