【摘要】 目的对乳腺癌保乳术后患者设计野中野调强放射治疗（FIF-IMRT）、混合调强放射治疗（Hy-IMRT）、静态调强放射治疗（S-IMRT）、容积旋转调强放射治疗（VMAT）四种不同放疗计划,比较四种不同放疗计划模式下的剂量学差异。方法纳入于2019年1月至6月在广西医科大学第一附属医院确诊为乳腺癌且行保乳术后的22例患者,左、右侧各11例,分别设计FIF-IMRT、Hy-IMRT、S-IMRT、VMAT四种放疗计划,处方剂量均为50 Gy/25次。通过剂量体积直方图（DVH）采用非参数检验方法比较靶区剂量及危及器官受照剂量分布的差异。结果四种放疗计划在PTV的D_2%、D_98%、D_50%、均匀性指数（HI）、适形度指数（CI）、V₁₀₅、V₁₁₀方面比较,差异均有统计学意义（P<0.05）。四种放疗计划患侧肺V₅、V₁₀,健侧肺D_max、D_mean,健侧乳腺D_max、D_mean,脊髓D_max、D_mean比较,差异均有统计学意义（P<0.05）。左侧乳腺癌四种放疗计划的心脏V₅、V₁₀、V₄₀、D_mean、D_max,右侧乳腺癌四种放疗计划的心脏V₅、V₁₀、V₂₀、D_mean、D_max比较,差异均有统计学意义（P<0.05）。结论在乳腺癌保乳术后的放疗计划设计中,优先考虑Hy-IMRT,其次当靶区的HI和CI以及靶区内高剂量体积在可接受的情况下可以考虑FIF-IMRT,而当心、肺、肝的低剂量区在可接受的范围内可以适当考虑S-IMRT和VMAT。更多还原

【Abstract】 Objective To design four different radiotherapy plans of field-in-field intensity-modulated radiation therapy（FIF-IMRT）, hybrid intensity-modulated radiation therapy（Hy-IMRT）, static intensity-modulated radiation therapy（S-IMRT）and volumetric modulated arc therapy（VMAT） for breast cancer patients after breast-conserving surgery, and to compare the dosimetry differences of the four different radiotherapy plans. Methods A total of 22 patients who were diagnosed with breast cancer and underwent breast-conserving surgery in the first affiliated hospital of Guangxi medical university from January to June 2019 were included, including 11 patients on the left and 11 on the right, respectively. Four radiotherapy plans of FIF-IMRT, HY-IMRT, S-IMRT and VMAT were designed respectively, and the prescribed dose was 50 Gy/25 times. The dose volume histogram（DVH） was used to compare the differences of target dose and dose distribution of endangered organs by nonparametric test. Results There were statistically significant differences in D_2%, D_98%, D_50%,homogeneity index（HI）, conformosity index（CI）, V₁₀₅ and V₁₁₀ of PTV among the four radiotherapy plans（P<0.05）. There were statistically significant differences in V₅ and V₁₀ of affected lung, D_maxand D_meanof healthy lung, D_maxand D_meanof healthy breast, D_maxand D_meanof spinal cord of the four radiotherapy plans（P <0.05）. There were statistically significant differences in V₅, V₁₀, V₄₀, D_meanand D_maxof the hearts of the four radiotherapy plans for left breast cancer and V₅, V₁₀, V₂₀,D_meanand D_maxof the hearts of the four radiotherapy plans for right breast cancer（P <0.05）. Conclusion In the design of radiotherapy plans for breast cancer after breast-conserving surgery, the priority should be given to HY-IMRT. Then, when the HI and CI of the target region and the high-dose volume of the target region are acceptable, the FIF-IMRT can be considered, while the S-IMRT and VMAT can be considered in the low-dose region of the heart, lung and liver within the acceptable range.更多还原