中华放射医学与防护杂志

杨继明,程杭,胡睿,等.三种全乳联合瘤床同步推量放疗技术的剂量学与放射生物学研究[J].中华放射医学与防护杂志,2024,44(9):764-770.Yang Jiming,Cheng Hang,Hu Rui,et al.Dosimetric and radiobiological differences in three radiotherapy techniques of whole breast irradiation with simultaneous integrated boost[J].Chin J Radiol Med Prot,2024,44(9):764-770

三种全乳联合瘤床同步推量放疗技术的剂量学与放射生物学研究

Dosimetric and radiobiological differences in three radiotherapy techniques of whole breast irradiation with simultaneous integrated boost

投稿时间：2024-02-15

DOI：10.3760/cma.j.cn112271-20240215-00056

中文关键词: 早期乳腺癌剂量正常组织并发症概率二次癌症风险超额绝对风险

英文关键词:Early breast cancer Dose Normal tissue complication probability Secondary cancer risk Excess absolute risk

基金项目:宁波市科技局公益项目(2023S046);余姚市科技局医疗卫生科技计划平台项目(2021YPT02);浙江省抗癌协会物理技术专委会第一届专项科研基金

作者	单位	E-mail
杨继明	宁波大学附属第一医院放化疗中心, 宁波 315000
程杭	余姚人民医院放疗技术科, 宁波 315400
胡睿	苏州市立医院南京大学附属苏州医院放疗科, 苏州 215000
戴许豪	宁波大学附属第一医院放化疗中心, 宁波 315000
吴勇	兴义市人民医院放疗科, 兴义 562400
娄鹏荣	宁波大学附属第一医院放化疗中心, 宁波 315000
周建良	宁波大学附属第一医院放化疗中心, 宁波 315000
郭建新	宁波大学附属第一医院放化疗中心, 宁波 315000
任江平	宁波大学附属第一医院放化疗中心, 宁波 315000	fyyrenjiangping@nbu.edu.cn

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中文摘要:

目的对比3种早期乳腺癌保乳术后全乳联合瘤床同步推量放疗(WBI-SIB)计划的剂量和放射生物学差异。方法回顾性选择20例早期左侧乳腺癌保乳术后放疗患者的资料,以相同处方剂量和目标条件重新设计3种计划,包括混合调强放疗(HIMRT)、调强放疗(IMRT)和容积旋转调强放疗(VMAT)。比较靶区和危及器官剂量,以及特定器官的正常组织并发症概率(NTCP)和二次癌症风险(SCR)的差异。结果 VMAT较HIMRT和IMRT计划显著降低了患侧肺、心脏的各项剂量学指标,但增加了健侧肺、健侧乳腺D_mean以及健侧乳腺V₅ _Gy,差异均有统计学意义(P ＜ 0.05)。VMAT计划心源性死亡、放射性肺炎以及肺纤维化的平均NTCP分别为0.41%、1.62%和23.59%,较其他两种技术显著降低(P ＜ 0.05)。IMRT与HIMRT相比,危及器官(OAR)的10项剂量学指标差异均无统计学意义(P>0.05),但NTCP分析发现IMRT的心源性死亡(t= 2.70, P ＜ 0.05)和肺纤维化(t=4.11, P ＜ 0.05)风险较HIMRT有小幅下降。此外,VMAT对健侧肺的超额绝对风险(EAR)分别是HIMRT与IMRT的1.65倍和1.83倍(z= -3.92,t= -6.43, P ＜ 0.05),健侧乳腺的EAR分别是其他两种技术的2.79倍和2.65倍(z = -3.21、-3.70,P ＜ 0.05)。结论对于早期乳腺癌的WBI-SIB调强放疗,VMAT对心脏和患侧肺的保护最好,但对侧乳腺和对侧肺的SCR最高。对年轻或心肺功能健康的早期乳腺癌患者使用VMAT技术需要格外重视减少对侧乳腺组织的低剂量辐射,以尽可能降低SCR风险;而对于已经存在明显心肺风险或年龄较大的患者,VMAT技术可能获益更大。

英文摘要:

Objective To identify the dosimetric and radiobiological differences of three radiotherapy techniques of whole breast irradiation with simultaneous integrated boost (WBI-SIB) following breast-conserving surgery for early breast cancer (EBC). Methods The data of 20 patients with early left-sided breast cancer who received radiotherapy following breast-conserving surgery were retrospectively analyzed. Three radiotherapy techniques, namely hybrid intensity-modulated radiotherapy (HIMRT), intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT), were redesigned with the same prescription dose and target conditions. Then, doses to target volume (TV) and organs at risk (OAR), along with the normal tissue complication probability (NTCP) and secondary cancer risk (SCR) for specific organs, were compared. Results Compared to HIMRT and IMRT, VMAT led to significant decreases in various dosimetric indices of the affected lung and heart and increases in the D_mean doses to the healthy lung and healthy breast and V₅ _Gy doses to the healthy breast, with the differences being significantly different (P < 0.05). The average NTCP values of cardiac death, radiation pneumonitis, and pulmonary fibrosis induced by VMAT were 0.41%, 1.62%, and 23.59%, respectively, significantly lower than those caused by other two techniques (P < 0.05). No statistical differences were found in 10 dosimetric indices of OAR between IMRT and HIMRT, while the NTCP analysis suggested that the risks of cardiac death (t= 2.70, P < 0.05) and pulmonary fibrosis (t=4.11, P < 0.05) induced by IMRT were slightly lower than those caused by HIMRT. In addition, the excess absolute risk (EAR) to the healthy lung posed by VMAT was 1.65 and 1.83 times those induced by HIMRT and IMRT, respectively (z= -3.92, t= -6.43, P < 0.05). In contrast, the EAR to the healthy breast induced by VMAT was 2.79 and 2.65 times those posed by HIMRT and IMRT, respectively (z= -3.21, -3.70, P < 0.05). Conclusions Among three intensive-modulated radiotherapy techniques of WBI-SIB for EBC, VMAT provides the optimal protection for the heart and affected lung but leads to the highest SCR to the healthy lung and breast. When VMAT is employed for young EBC patients or those with normal cardiopulmonary function, special attention should be paid to reducing low-dose irradiations to the healthy breast and thereby minimizing SCR. In contrast, VMAT might be more favorable for patients with pronounced cardiopulmonary risks or aged patients.

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