中华放射医学与防护杂志

蒋中凯,方春锋,李芦芦,等.双侧乳腺癌质子调强与光子容积旋转调强放疗计划的剂量学评价研究[J].中华放射医学与防护杂志,2025,45(7):647-654.Jiang Zhongkai,Fang Chunfeng,Li Lulu,et al.Dosimetric evaluation of intensity modulated proton therapy and photon volumetric modulated arc therapy for bilateral breast cancer[J].Chin J Radiol Med Prot,2025,45(7):647-654

双侧乳腺癌质子调强与光子容积旋转调强放疗计划的剂量学评价研究

Dosimetric evaluation of intensity modulated proton therapy and photon volumetric modulated arc therapy for bilateral breast cancer

投稿时间：2024-07-16

DOI：10.3760/cma.j.cn112271-20240716-00262

中文关键词: 双侧乳腺癌容积弧形调强放疗质子调强放疗计划质量

英文关键词:Bilateral breast cancer Volumetric modulated arc therapy Intensity modulated proton therapy Plan quality

基金项目:

作者	单位	E-mail
蒋中凯	河北一洲肿瘤医院物理技术部, 涿州 072750
方春锋	河北一洲肿瘤医院物理技术部, 涿州 072750
李芦芦	日照市人民医院放疗科, 日照 276827
王子申	河北一洲肿瘤医院物理技术部, 涿州 072750
李玉梅	河北一洲肿瘤医院物理技术部, 涿州 072750
徐寿平	国家癌症中心国家肿瘤临床医学中心中国医学科学院北京协和医学院肿瘤医院放疗科, 北京 100021	shouping_xu@yahoo.com

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中文摘要:

目的评价质子调强放疗(IMPT)和光子容积旋转调强放疗(VMAT)在双侧乳腺癌保乳术后患者放疗计划中的剂量学特点。方法选取18例双侧乳腺癌患者的CT定位图像,完成靶区及危及器官的勾画,对所有病例均分别制定IMPT和VMAT放疗计划,其中IMPT计划又分别设计了基于临床靶区(CTV)理念、使用鲁棒性优化(RO)的RO-IMPT计划和基于计划靶区(PTV)理念、不使用RO的NonRO-IMPT计划,即RO-IMPT组、NonRO-IMPT组和VMAT组3组放疗计划,最后统一归一到处方剂量覆盖95%的靶区体积。分析评价靶区及各危及器官的剂量学参数并探讨两种技术的剂量学特点。结果靶区方面,RO-IMPT组CTV靶区D_1%、D_mean、剂量均匀指数(HI)均低于VMAT组PTV (t=-8.96、-8.21、-8.13,P<0.05),D_99%高于VMAT组PTV (t=4.96,P<0.05);NonRO-IMPT组PTV靶区D_1%、D_mean、HI均低于VMAT组PTV (t=-7.75、-6.25、-6.11,P<0.05)。靶区剂量适形指数(CI)高于VMAT组PTV (t=7.53,P<0.05)。危及器官方面,两组IMPT计划全肺V₅~V₃₀、D_mean,心脏V₅~V₄₀、D_mean,冠状动脉左前降支(LAD)D_1%、D_mean,脊髓D_1%,正常组织(NT)D_mean,和皮肤D_mean均低于VMAT组(t=-28.47~-3.25,P<0.05)。其余评估指标间差异均无统计学意义(P>0.05)。结论 IMPT和VMAT均可满足双侧乳腺癌保乳术后放疗计划的临床要求。在危及器官保护上,IMPT技术相较于VMAT技术具有较为明显的优势。

英文摘要:

Objective To evaluate the dosimetric characteristics of intensity-modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT) in radiation therapy planning for patients with bilateral breast cancer after breast-conserving surgery. Methods On the computed tomography localization images of 18 patients with bilateral breast cancer, target volumes and organs at risk were contoured to develop both IMPT and VMAT plans for each patient. Two IMPT plans were designed based on the clinical target volume (CTV) with robust optimization (RO-IMPT) and the planning target volume (PTV) without RO (NonRO-IMPT), respectively. The RO-IMPT, NonRO-IMPT, and VMAT plans were normalized such that the prescription dose could cover 95% of the target volume. The dosimetric parameters of target volumes and organs at risk were evaluated, and the dosimetric characteristics of the two techniques were compared. Results In terms of target volumes, the RO-IMPT group showed significantly lower D_1%, D_mean, and homogeneity index (HI) and a significantly higher D_99% of the CTV than those of the PTV in the VMAT group (t=-8.96, -8.21, -8.13, 4.96, P<0.05). The NonRO-IMPT group showed significantly lower D_1%, D_mean, and HI and a significantly higher conformity index of the PTV than those of the PTV in the VMAT group (t=-7.75, -6.25, -6.11, 7.53, P<0.05). In terms of organs at risk, the two IMPT groups showed significantly lower values than the VMAT group for the V₅-V₃₀ and D_mean of the whole lungs, V₅-V₄₀ and D_mean of the heart, D_1% and D_mean of the left anterior descending coronary artery, D_1% of the spinal cord, D_mean of normal tissues, and D_mean of the skin (t= -28.47 to -3.25, P<0.05). There was no significant difference in any other evaluation indices (P>0.05). Conclusions Both IMPT and VMAT can meet the clinical requirements of radiotherapy plans following breast-conserving surgery for bilateral breast cancer. IMPT has apparent advantages over VMAT in protecting organs at risk.

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