| 王勇,孙彦泽,韩文敏,等.可视化温感变色补偿膜在乳腺癌根治术后放疗的应用研究[J].中华放射医学与防护杂志,2025,45(5):431-437.Wang Yong,Sun Yanze,Han Wenmin,et al.Application of visualized thermosensitive color-changing bolus in postmastectomy radiotherapy for breast cancer[J].Chin J Radiol Med Prot,2025,45(5):431-437 |
| 可视化温感变色补偿膜在乳腺癌根治术后放疗的应用研究 |
| Application of visualized thermosensitive color-changing bolus in postmastectomy radiotherapy for breast cancer |
| 投稿时间：2024-08-08 |
| DOI：10.3760/cma.j.cn112271-20240808-00301 |
| 中文关键词: 乳腺癌 根治术后放疗 可视化 温度感应 组织补偿膜 |
| 英文关键词:Breast cancer Postmastectomy radiotherapy (PMRT) Visualized thermosensitive Tissue compensator (bolus) |
| 基金项目:“十四五”江苏省医学重点学科建设单位(肿瘤治疗学科)(JSDW202236);苏州市科技计划(医疗卫生科技创新)项目(SKY2022167);苏州大学附属第二医院科研预研基金(SDFEYHT2429) |
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| 中文摘要: |
| 目的 探讨可视化温感变色补偿膜在乳腺癌根治术后放疗(PMRT)中的应用可行性和优势。方法 回顾性选取2023年6月至2024年6月苏州大学附属第二医院乳腺癌根治术后需要放疗的患者40例,按照随机标签法分为A组(试验组)和B组(对照组),每组20例。A组患者扫描两次CT,分别为不加补偿膜的A1图像和添加可视化温感变色补偿膜的A2图像,治疗时使用可视化温感变色补偿膜。B组同样扫描两次CT,分别为不加补偿膜的B1图像和添加常规商用补偿膜的B2图像,治疗时使用常规商用补偿膜。在放疗计划中,A1和A2图像分别设计为A1-Plan和A2-Plan以及将A1-Plan移植到A2图像上的A3-Plan,B1和B2图像分别设计为B1-Plan和B2-Plan以及B1-Plan移植到B2图像上的B3-Plan,射野和目标优化函数相同。比较各组计划间的剂量学差异及皮肤不良反应。结果 A组中,A1-Plan与A2-Plan比较,危及器官(患侧肺V5 Gy、V10 Gy、V20 Gy,心脏Dmean,健侧乳腺Dmean,皮肤Dmax和Dmean)剂量、靶区均匀性指数(HI)、适形度指数(CI)、处方剂量体积V50 Gy、Dmax、机器跳数(MU)差异均无统计学意义(P>0.05)。在B组中,B3-Plan与B1-Plan相比,靶区覆盖度(89.9% vs. 95%)、HI(0.153 vs. 0.136)、CI(0.817 vs. 0.810)有所下降,但危及器官受量差异无统计学意义(P>0.05)。A3-Plan与B3-Plan相比,靶区覆盖度(94.05% vs. 89.90%)、最大剂量(5 665.4 cGy vs. 5 632.7 cGy)、HI(0.148 vs. 0.163)、CI(0.830 vs. 0.820)和皮肤平均剂量(5 153.6 cGy vs. 5 048.2 cGy),差异均有统计学意义(t=2.78、2.29、-0.47、0.51、3.13,P<0.05)。相较于相同厚度的常规商用补偿膜,可视化温感变色补偿膜空腔体积明显缩小(3 833 mm3 vs. 21 498 mm3,t=-9.65,P<0.05)。两组患者皮肤不良反应均为1级。结论 与同厚度的常规商用补偿膜相比,可视化温感变色补偿膜在靶区覆盖度、HI和CI方面剂量学分布更佳,与皮肤贴合性更好,空腔可视化强,治疗分次间位置重复性好,有良好的实用性和安全性。 |
| 英文摘要: |
| Objective To explore the feasibility and advantages of applying visualized thermosensitive color-changing bolus in postmastectomy radiotherapy (PMRT) for breast cancer. Methods Forty patients with breast cancer treated with PMRT in the Second Affiliated Hospital of Soochow University from June 2023 to June 2024 were prospectively selected. They were randomly divided into test and control groups (also referred to as groups A and B, respectively), with 20 patients in each group. Group A, underwent two CT scans: the first scan without bolus (image A1) and the second scan with visualized thermosensitive color-changing bolus (image A2). They were treated with visualized thermosensitive color-changing bolus. Group B also underwent two CT scans: the first scan without bolus (image B1) and the second scan with conventional commercial bolus (image B2), and then were treated with conventional commercial bolus. In the radiotherapy planning, images A1 and A2 were designed as A1-Plan and A2-Plan, and A3-Plan was created by transferring the A1-Plan onto image A2. Images B1 and B2 were designed as B1-Plan and B2-Plan, and B3-Plan was created by transferring the B1-Plan onto image B2. The radiation fields and target optimization functions were identical. The dosimetric differences and skin toxicity reactions between different plans were compared. Results In Group A, A1-Plan and A2-Plan manifested no statistically significant differences (P > 0.05) in the doses to organs at risk (OARs), including the ipsilateral lung (V5 Gy, V10 Gy, V20 Gy), heart (Dmean), contralateral breast (Dmean), and skin (Dmax and Dmean), target homogeneity index (HI), conformity index (CI), prescription dose volume (V50 Gy), depth of maximum dose (Dmax), and monitor unit (MU). In Group B, B3-Plan compared to B1-Plan showed reduced V50 Gy (89.9% vs. 95%), HI (0.153 vs. 0.136), and CI (0.817 vs. 0.810), while the two plans displayed no statistically significant differences in doses to OARs. In contrast, A3-Plan and B3-Plan exhibited statistically significant differences (t = 2.78, 2.29, -0.47, 0.51, 3.13, P < 0.05) in V50 Gy (94.05% vs. 89.90%), Dmax (5665.4 cGy vs. 5 632.7 cGy), HI (0.148 vs. 0.163), CI (0.83 vs. 0.82), and skin Dmean (5153.6 cGy vs. 5048.2 cGy). Compared to the conventional commercial bolus of the same thickness, the visualized thermosensitive color-changing bolus yielded a significantly reduced air cavity volume (3833 mm3 vs. 21498 mm3, t = -9.65, P < 0.05). Both groups experienced only grade I skin toxicity reactions. Conclusions Compared to the conventional commercial bolus of the same thickness, the visualized thermosensitive color-changing bolus shows a more effective dosimetric distribution in terms of target coverage, HI, and CI, a higher fit to the skin, highly visualized air cavity, and higher positional repeatability in fractionated radiotherapy, demonstrating high practicality and safety. |
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