| 杨翠,杨昭志,胡伟刚,彭佳元.乳腺癌根治术后放疗中不同补偿物使用策略对剂量分布的影响[J].中华放射医学与防护杂志,2023,43(1):30-35 |
| 乳腺癌根治术后放疗中不同补偿物使用策略对剂量分布的影响 |
| Effects of different bolus strategies on doses in postmastectomy radiotherapy |
| 投稿时间：2022-08-04 |
| DOI：10.3760/cma.j.cn112271-20220804-00318 |
| 中文关键词: 乳腺癌 放疗 补偿物 皮肤剂量 |
| 英文关键词:Breast cancer Radiotherapy Bolus Skin dosimetry |
| 基金项目: |
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| 中文摘要: |
| 目的 比较和评估不同的补偿物的使用策略在乳腺癌根治术后常规调强放射治疗中对剂量分布的影响。方法 选择2021年4月至10月于复旦大学附属肿瘤医院收治50例乳腺癌根治术后患者,计划靶区包括胸壁、内乳淋巴结、腋窝淋巴结和锁骨上淋巴结4个部分,处方剂量为50Gy/25次。每位患者分别制作使用3种不同厚度补偿物(3、5、10mm)的调强放疗计划,统计和评估不同补偿物厚度和使用次数对靶区覆盖率、胸壁皮肤高剂量体积和周围正常组织的剂量影响。结果 补偿物全程使用时,使用10mm补偿物的靶区V95%较使用3、5mm的低(F=3.40,P<0.05),使用3mm补偿物的适形指数(CI)最高(F=50.05,P<0.05),3种计划皮肤V105%和V110%对比差异无统计学意义(P>0.05)。随着使用次数的减少,靶区V95%和皮肤V105%均降低,补偿物使用20次时,靶区V95%的值变化很小(<1%),而皮肤V105%急剧降低为初始值的一半左右。补偿物使用15次时,3种计划的靶区V95%,CI和均匀性指数(HI)对比差异无统计学意义(P>0.05),使用3mm补偿物的Dmax值较使用5、10mm低(F=9.21,P<0.05)。正常组织方面,补偿物厚度和使用次数对心脏和患侧肺的剂量分布影响很小,差异不致引起生物学效应的不同。结论 对于乳腺癌根治术后调强放疗技术,不同补偿物厚度对靶区、皮肤、心脏和肺的剂量影响很小。补偿物的使用次数是决定靶区覆盖和皮肤剂量的重要决定因素。 |
| 英文摘要: |
| Objective To comprehensively evaluate the effects of different bolus usages in postmastectomy intensity-modulated radiotherapy (PM-IMRT) on doses. Methods Fifty patients receiving PM-IMRT at Fudan University Shanghai Cancer Center from April to October 2021 were retrospectively studied. The planning target volume (PTV) was divided into four parts, namely chest wall (CW), internal mammary node, retained axillary lymph node, and supraclavicular node. The prescription dose was 50 Gy/25 fractions. Three PM-IMRT plans applying boluses with different thicknesses (3, 5 and 10 mm) were designed for each patient. The effects of different thicknesses and usage frequencies of boluses on PTV coverage, high dose volume of the CW skin, and dose to surrounding normal tissues were comprehensively evaluated.Results When boluses were applied throughout the PM-IMRT, the PTV V95% of plans applying 10 mm-thick boluses was lower than that of plans applying 3 and 5 mm-thick boluses (F=3.340, P<0.05), the CI of plans applying 3 mm-thick boluses was higher than that of plans applying 5 and 10 mm-thick boluses (F=50.05, P<0.05), and there was no statistically significant differences in the skin V105% and V110% of three plans(P>0.05). Both PTV V95% and skin V105% were reduced with a decrease in the usage frequency of boluses. At a frequency of 20, PTV V95% decreased slightly (<1%), while skin V105% decreased sharply to nearly half of the original values. At a frequency of 15, the PTV V95%, CI, and HI in the three plans showed no statistically significant dosimetric differences (P>0.05). The PTV Dmax of plans applying 3 mm-thick boluses was lower than that of plans applying 5 and 10 mm-thick boluses (F=9.21, P<0.05). As for the dose to surrounding normal tissues, different bolus thicknesses and frequencies had negligible effects on doses to heart and lung, causing little different biological effects.Conclusions For PM-IMRT, different bolus thicknesses have similar effects on doses to the PTV, skin, heart, and lung. Bolus usage frequency, rather than thickness, was the major factor determining the PTV coverage and the dose to CW skin. |
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