| 贺先桃,许卓华,龙雨松,等.乳腺癌即刻乳房重建术后放疗在3种不同放疗技术下的对比研究[J].中华放射医学与防护杂志,2025,45(4):317-324.He Xiantao,Xu Zhuohua,Long Yusong,et al.A comparative study of radiotherapy using three distinct radiotherapy techniques following immediate breast reconstruction for breast cancer[J].Chin J Radiol Med Prot,2025,45(4):317-324 |
| 乳腺癌即刻乳房重建术后放疗在3种不同放疗技术下的对比研究 |
| A comparative study of radiotherapy using three distinct radiotherapy techniques following immediate breast reconstruction for breast cancer |
| 投稿时间：2024-08-20 |
| DOI：10.3760/cma.j.cn112271-20240820-00312 |
| 中文关键词: 乳腺肿瘤 即刻乳房重建 调强放射疗法 剂量学 |
| 英文关键词:Breast neoplasms Immediate breast reconstruction Intensity modulated radiotherapy Dosimetry |
| 基金项目:广西卫生健康委员会自筹经费科研课题(Z-B20231377);中央引导地方项目(2022YRZ0101);广西重点研发计划项目(2021AB12033) |
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| 中文摘要: |
| 目的 研究螺旋断层放疗(HT)、容积调强弧形放疗(VMAT)和固定野调强放疗( F_IMRT )在乳腺癌即刻乳房重建术后放疗中的靶区和危及器官(OAR)剂量学、重建组织受照剂量、治疗出束时间差异,为临床放疗技术的选择提供参考。方法 回顾性分析选取2018年8月至2023年7月于柳州市工人医院行改良根治术+即刻乳房重建术后放疗的15例乳腺癌患者为研究对象,靶区勾画时均需避开重建组织并将其单独勾画出来,对每例患者分别设计HT计划、VMAT计划和 F_IMRT 计划。所得所有计划按放疗技术不同分为HT组、VMAT组和 F_IMRT 组。采用单因素方差分析方法进行比较,结果有差异时进一步多重比较。结果 3组计划间的靶区各项参数差异均有统计学意义(F = 38.73、14.95、37.01、48.05、35.55、22.56、34.30,P < 0.05);两两比较显示HT组、VMAT组的靶区最大剂量D2%、最小剂量D98%、平均剂量Dmean、靶区内高剂量体积占比(V107%和V110%)均显著优于 F_IMRT 组,HT组能提供最优的适形指数CI,而VMAT组均匀性指数HI要明显好于其他两组。OAR方面,患侧肺的V20在 HT组中最低(F = 14.31,P < 0.05), F_IMRT 组中最高(F = 14.31,P < 0.05),但HT组中患侧肺和健侧肺的V5、Dmean均明显高于其他两组(F = 39.16、31.91,P < 0.05);VMAT组相比其他两组明显降低了健侧乳腺的平均剂量Dmean(F = 5.57,P < 0.05);其他OAR心脏、脊髓危及器官计划体积(PRV)、甲状腺、肱骨头等的受照剂量差异无统计学意义(P>0.05)。重建组织的受照剂量(Dmax、V53.5、Dmean)比较为HT组＜VMAT组＜ F_IMRT 组(F = 17.69、17.53、15.11,P < 0.05)。HT组和 F_IMRT 组的治疗出束时间相近(P>0.05),但两者均几倍多于VMAT组(F = 28.72,P < 0.05)。结论 3种放疗技术经对比分析后各有优势和不足,但 F_IMRT 技术的综合优势最小;HT在提供更好的靶区适形度的同时还能降低重建组织的整体受量以及重要指标患侧肺的V20;VMAT技术治疗效率最高,且能带来更优的靶区剂量均匀性和更低的健侧乳腺受照剂量;建议根据临床实际情况优先选用HT或VMAT。 |
| 英文摘要: |
| Objective To investigate the differences in dosimetric parameters for target volumes and organs at risk (OARs), radiation doses to reconstructed tissues, and beam-on time in radiotherapy among helical tomotherapy (HT), volumetric modulated arc therapy (VMAT), and fixed-field intensity-modulated radiotherapy ( F_IMRT ) following immediate breast reconstruction for breast cancer, thereby providing a reference for the selection of clinical radiotherapy techniques. Methods This study retrospectively investigated 15 breast cancer patients who underwent radiotherapy following modified radical mastectomy and immediate breast reconstruction at the Liuzhou Worker's Hospital from August 2018 to July 2023. During target volume delineation, precautions were taken to avoid the reconstructed tissues, which were delineated separately. Customized HT, VMAT, and F_IMRT treatment plans were designed for each patient. The plans were categorized into the HT, VMAT, and F_IMRT groups based on different radiotherapy techniques employed. They were comparatively analyzed through one-way analysis of variance (ANOVA), with multiple comparisons further conducted in the case of significant differences. Results Statistical analyses reveal significant differences in various parameters of target volumes among the three groups of plans (F = 38.73, 14.95, 37.01, 48.05, 35.55, 22.56, 34.30,P < 0.05). Pairwise comparisons indicate that the maximum dose (D2%), minimum dose (D98%), mean dose (Dmean), and the proportion of high-dose volumes within the target volume (V107%and V110%) in both the HT and VMAT groups were significantly better than those in the F_IMRT group. The HT group demonstrated the optimal conformity index (CI), while the VMAT group displayed the superior homogeneity index (HI) compared to the other two groups. In terms of OAR, the V20 of the ipsilateral lung was the lowest in the HT group (F = 14.31,P < 0.05) and the highest in the F_IMRT group (F = 14.31,P < 0.05). However, the V5 and Dmean for both the ipsilateral and contralateral lungs in the HT group significantly surpassed those of the other groups (F = 39.16, 31.91,P < 0.05). The mean dose Dmean (F = 5.57,P < 0.05) of the contralateral breast was significantly reduced in the VMAT group compared to the other two groups. No statistically significant differences were observed for other OARs, including the heart, spinal cord PRV, thyroid, and humeral head (P> 0.05). The radiation doses to reconstructed tissues (Dmax, V53.5, Dmean) ascended in the order of HT, VMAT, and F_IMRT groups (F = 17.69, 17.53, 15.11,P < 0.05). The HT and F_IMRT groups showed similar beam-on times (P> 0.05), both exceeding that of the VMAT group by several folds (F = 28.72,P < 0.05). Conclusions The comparative analysis indicates that the three radiotherapy techniques exhibit distinct advantages and limitations, with F_IMRT demonstrating the least comprehensive advantage. HT can enhance the conformity of target volumes while reducing the overall radiation doses to reconstructed tissues and the crucial indicator V20 in the ipsilateral lung. VMAT demonstrates the highest treatment efficiency, yielding improved dose uniformity in the target volume and reduced radiation doses to the contralateral breast. It is advisable to prioritize HT or VMAT based on actual clinical conditions. |
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