| 孙向上,周波蓉,黄仕雄,等.左侧乳腺癌根治术后深吸气屏气技术对摆位误差所致剂量影响的鲁棒性分析[J].中华放射医学与防护杂志,2026,46(3):264-272.Sun Xiangshang,Zhou Borong,Huang Shixiong,et al.Robustness analysis of deep inspiration breath-hold technique against dosimetric variations induced by positioning errors for postoperative left-sided breast cancer[J].Chin J Radiol Med Prot,2026,46(3):264-272 |
| 左侧乳腺癌根治术后深吸气屏气技术对摆位误差所致剂量影响的鲁棒性分析 |
| Robustness analysis of deep inspiration breath-hold technique against dosimetric variations induced by positioning errors for postoperative left-sided breast cancer |
| 投稿时间：2025-05-27 |
| DOI：10.3760/cma.j.cn112271-20250527-00179 |
| 中文关键词: 乳腺癌 根治术后放疗 摆位误差 深吸气屏气 |
| 英文关键词:Breast cancer Postoperative adjuvant radiotherapy Positioning error Deep inspiration breath-hold |
| 基金项目:湖南省自然科学基金面上项目(2023JJ30373);湖南省肿瘤医院科研攀登计划启航青年基金(QH2023010) |
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| 中文摘要: |
| 目的 分析深吸气屏气(DIBH)技术在左侧乳腺癌根治术后调强放疗中对摆位误差所致剂量影响的鲁棒性,为实际临床治疗提供参考。方法 按简单随机抽样法回顾性选取2023年9月至2024年9月于湖南省肿瘤医院行深吸气屏气技术和自由呼吸(FB)的左侧乳腺癌根治术后患者各17例,采用容积旋转调强照射技术进行治疗。通过单方向移动临床计划的治疗中心5 mm以模拟实际治疗过程中的摆位偏移,分析不同呼吸相下摆位误差对临床靶区(CTV)、危及器官剂量学参数的影响。结果 将两组已批准治疗计划进行对比,DIBH组患者靶区剂量覆盖率CTV-V49有提高(t= 2.56, P<0.05),左肺V5、V20、心脏和冠状动脉左前降支(LAD)的平均剂量(Dmean)以及剂量体积参数V20、V30、V40有明显降低,差异有统计学意义(t=-5.33~-2.09, P＜0.05)。两组患者的右肺V5、右侧乳腺Dmean差异无统计学意义(P>0.05)。在5 mm单向摆位误差扰动下,DIBH和FB组患者靶区剂量覆盖率都有降低,分别下降了0.79%~2.67%和0.82%~3.50%,但仍满足临床要求。FB患者心脏、LAD、左肺的待评估剂量体积参数变化范围为-2.55%~3.51%,-21.54%~23.23%,-4.58%~4.18%;DIBH患者心脏、LAD,以及左肺相应的待评估剂量体积参数变化范围为-1.14%~1.98%,-13.68%~15.45%,-4.08%~3.37%,DIBH组患者心脏、LAD、左肺的剂量变化小于FB组患者。结论 与FB相比,DIBH技术在左乳根治术后放疗中的靶区覆盖、心脏、左肺等危及器官保护方面具有剂量学优势,特别是在摆位误差场景下,表现出更优的鲁棒性。 |
| 英文摘要: |
| Objective To investigate the robustness of deep inspiration breath-hold (DIBH) technique against dosimetric variations caused by positioning errors during intensity-modulated radiotherapy for postoperative left-sided breast cancer, and to provide a reference for clinical treatment. Methods A retrospective study was conducted using simple random sampling to select 34 patients who underwent postoperative radiotherapy for left-sided breast cancer at Hunan Cancer Hospital between September 2023 and September 2024. Among them, 17 patients were treated with the DIBH technique and 17 with free breathing (FB). All patients received volumetric modulated arc therapy(VMAT). Positioning errors during actual treatment were simulated by shifting the isocenter of the clinical plan by 5 mm along individual coordinate axes. The effects of positioning errors on dosimetric parameters for the clinical target volume (CTV) and organs at risk were analyzed with different breathing techniques. Results With the approved clinical plan, the DIBH group showed a higher percentage of the CTV receiving ≥49 Gy (t = 2.56, P<0.05), significantly lower percentages of left lung receiving ≥5 and ≥20 Gy, and significantly lower mean doses to the heart and left anterior descending coronary artery (LAD) and percentages of the heart and LAD receiving ≥20, ≥30, and ≥40 Gy (t = -5.33 to -2.09, P<0.05), as compared with the FB group. No statistically significant differences were found in the percentage of the right lung receiving ≥5 Gy or the mean dose to the right breast between the two groups. Under 5 mm unidirectional positioning errors, the percentages of the CTV receiving ≥49 Gy decreased in the DIBH and FB groups by 0.79%-2.67% and 0.82%-3.50%, respectively, though the percentages still met clinical requirements. In the FB group, the variations in the assessed dose-volume parameters for the heart, LAD, and left lung ranged from -2.55% to 3.51%, -21.54% to 23.23%, and -4.58% to 4.18%, respectively. Comparatively, the DIBH group demonstrated narrower variation ranges of -1.14% to 1.98% for the heart, -13.68% to 15.45% for the LAD, and -4.08% to 3.37% for the left lung. Conclusions Compared with FB, the DIBH technique offers dosimetric advantages in target coverage and sparing of organs at risk such as the heart and left lung during postoperative radiotherapy for left-sided breast cancer. It also demonstrates superior robustness in scenarios involving positioning errors. |
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