| 姚凯宁,王美娇,刘嘉城,等.保乳术后乳腺癌自适应放疗在Ethos平台不同射野策略旋转调强计划的剂量学与鲁棒性比较[J].中华放射医学与防护杂志,2026,46(9):845-855.Yao Kaining,Wang Meijiao,Liu Jiacheng,et al.Comparison of dosimetric parameters and robustness of volumetric modulated arc therapy plans using different beam arrangement strategies on the Ethos platform for adaptive radiotherapy after breast-conserving surgery in breast cancer[J].Chin J Radiol Med Prot,2026,46(9):845-855 |
| 保乳术后乳腺癌自适应放疗在Ethos平台不同射野策略旋转调强计划的剂量学与鲁棒性比较 |
| Comparison of dosimetric parameters and robustness of volumetric modulated arc therapy plans using different beam arrangement strategies on the Ethos platform for adaptive radiotherapy after breast-conserving surgery in breast cancer |
| 投稿时间：2026-03-11 |
| DOI：10.3760/cma.j.cn112271-20260311-00092 |
| 中文关键词: 乳腺癌 自适应放疗 射野优化 计划鲁棒性 旋转调强放疗 |
| 英文关键词:Breast cancer Adaptive radiotherapy Beam arrangement optimization Plan robustness Volumetric modulated arc therapy |
| 基金项目:国家自然科学基金（12375335，12005007）；北京市自然科学基金（25JL001）；北京大学肿瘤医院科学研究基金（ZY202410） |
|
| 摘要点击次数: 220 |
| 全文下载次数: 3 |
| 中文摘要: |
| 目的 评估乳腺癌自适应放疗中自定义射野优化策略对计划质量的提升，探讨其在Ethos平台上的可行性与剂量学优势。方法 回顾性纳入2022年1月至2024年12月北京大学肿瘤医院的 40例保乳术后患者（左、右侧各20例），在Ethos平台模拟在线自适应流程。分别以4种Ethos标准射野模板及1种基于Eclipse的自定义容积调强射野生成计划。比较靶区覆盖、危及器官剂量、适形性、计划跳数与鲁棒性。结果 自定义射野计划在左、右侧病例中均可改善靶区覆盖（CTV D 100%、PTV D 95%显著提高，W 左侧 = 0.82、0.64、0.56，W 右侧 = 0.20、0.61、0.48，P<0.05）与适形性（CI值更优，W 左侧 = 0.46、0.19，W 右侧 = 0.10，P<0.05），同时显著降低心脏、患侧肺及肝脏剂量（W 左侧=0.38、0.46、0.28、0.35，W 右侧=0.28、0.27、0.32，P<0.05），且健侧低剂量外溢更少。计划跳数与Ethos VMAT计划相当。鲁棒性分析显示，自定义射野计划在摆位误差下剂量指标变化更小，更加稳健。结论 Eclipse自定义射野导入Ethos优化策略在乳腺癌自适应放疗中具有明确剂量学优势，可提升靶区覆盖与危及器官保护，计划鲁棒性更优，为个体化精准放疗提供了新的技术路径。 |
| 英文摘要: |
| Objective To evalucate the improvement in plan quality achieved by a customized beam arrangement optimization strategy in adaptive radiotherapy for breast cancer, and to explore its feasibility and dosimetric advantages on the Ethos platform.Methods Totally 40 patients who underwent breast-conserving surgery (20 left-sided and 20 right-sided) were retrospectively enrolled from Peking University Cancer Hospital between January 2022 and December 2024. Online adaptive radiotherapy workflows were simulated using the Ethos platform. Plans were generated using four standard Ethos beam arrangement templates and one Eclipse-based customized beam arrangement for volumetric modulated arc therapy. Target coverage, doses to organs at risk, conformity, monitor units, and robustness were compared.Results In both left- and right-sided cases, the customized beam arrangement improved target coverage (the doses received by 100% of the clinical target volume and by 95% of the planning target volume were significantly increased, W left=0.82, 0.64, 0.56, W right=0.20, 0.61, 0.48, P<0.05) and conformity (conformity index was significantly improved, W left=0.46, 0.19, W right=0.10, P<0.05). Moreover, doses to the heart, ipsilateral lung, and liver were significantly reduced (W left=0.38、0.46、0.28、0.35，W right=0.28、0.27、0.32，P<0.05), and there was less low-dose spillage to the contralateral side. Plan monitor units were comparable to those of Ethos volumetric modulated arc therapy plans. In robustness analysis, the customized beam arrangement showed smaller variations in dosimetric parameters under setup errors, indicating improved robustness.Conclusions The strategy of importing Eclipse-based customized beam arrangements into Ethos for optimization has clear dosimetric advantages in adaptive radiotherapy for breast cancer. It can improve target coverage and organs-at-risk sparing, and has better plan robustness, providing a new technical pathway for personalized precision radiotherapy. |
| HTML 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|