【摘要】 目的:探讨深吸气屏气技术对乳腺癌术后放疗患者靶区剂量及摆位误差的影响，为临床治疗提供参考依据。方法:于2021年01月至2023年07月入组60例需要行乳腺癌术后放射治疗的患者，将患者随机分为深吸气屏气组和对照组（自由呼吸组）,深吸气屏气组30例，对照组30例，均采用容积调强放射治疗（volumetric modulated arc therapy, VMAT）技术进行计划设计，比较两组计划临床靶区（clinical target volume, CTV）、计划靶区（planning target volume, PTV）的体积及剂量学差异，肺的V₂₀、V₅及平均剂量，心脏V₂₀、V₃₀、V₄₀及平均剂量，脊髓的平均剂量、最大剂量，健侧乳腺平均剂量，深吸气屏气前后肺体积变化，靶区适形度指数（conformability index, CI）及靶区均匀性指数（homogeneity index, HI）。结果:将纳入的两组放疗计划方案进行对比，两组的摆位误差无统计学差异（P>0.05）。在保乳术后患者中，深吸气屏气组靶区PTV接受的平均剂量D_mean、最小剂量D_min、D₉₅、D₅相较于对照组增大，差异有统计学意义（P<0.05）;两组的CTV体积、PTV体积、D₅₀、D_max、HI及CI之间比较，差异无统计学意义（P>0.05）。在根治术后患者中，PTV的平均剂量D_mean、最大剂量D_max、最小剂量D_min、D₉₅、D₅、D₅₀与对照组比较，差异无统计学意义（P>0.05）;两组的CTV体积、PTV体积、HI及CI之间比较，差异也无统计学意义（P>0.05）。在保乳术后和根治术后患者中，深吸气屏气组的双肺V₅、V₂₀及患侧肺V₅、V₂₀、平均剂量D_mean相较于对照组减小，差异有统计学意义（P<0.05）;双肺D_mean两组之间比较，差异无统计学意义（P>0.05）。深吸气屏气组的心脏V₂₀、V₃₀、V₄₀、心脏D_mean均较对照组下降，差异有统计学意义（P<0.05）。两组的脊髓D_max、D_mean和健侧乳腺D_mean差异无统计学意义（P>0.05）。在深吸气屏气患者中，深吸气后左、右肺的体积与深吸气前比较，有统计学差异（P<0.05）。结论:应用深吸气屏气技术进行乳腺癌术后辅助放射治疗能够改善保乳术后患者靶区剂量分布，明显降低心脏、肺等危及器官的受照剂量。更多还原

【Abstract】 Objective:To investigate effects of deep inspiration breath-hold（DIBH） technique on target volume dose and setup errors of postoperative radiotherapy patients with breast cancer.Methods:From January 2021 to July 2023,60 patients who needed postoperative radiotherapy for breast cancer were enrolled.A total of 60 patients were randomized into two groups, 30 patients in DIBH group and 30 patients in control group.Treatment planning was done with VMAT techniques.The volume and dosimetry differences of CTV and PTV between the two groups were compared, and the V₅,V₂₀ and mean lung dose, V₂₀,V₃₀,V₄₀ and mean heart dose, the maximum spinal cord dose, the minimum spinal cord, mean healthy breast dose, lung volume before and after deep inspiration, homogeneity index（HI） of target volume and conformability index（CI） of target volume were compared.Results:Comparing the two groups included radiotherapy planning protocols, setup errors between the two groups were no statistically significant difference（P>0.05）.In patients after breast-conserving surgery, the mean dose(D_mean),minimum dose(D_min),D₉₅,and D₅ received by PTV in DIBH group were significantly increased compared with those in control group（P<0.05）. Comparison between the CTV volume,PTV volume,D50,Dmax,homogeneity index,and conformability index in the two groups showed no statistically significant difference（P> 0. 05）. In patients after radical surgery, the mean dose（Dmean）,maximum dose（Dmax）,minimum dose（Dmin）,D95,D5and D50received by PTV,CTV volume,PTV volume,homogeneity index and conformability index in DIBH group were no statistically significantly increased compared with those in control group（P> 0. 05）. In the DIBH group,the bilateral lungV5,V20and the affected lungV5,V20,and the mean dose（Dmean） were reduced compared with the control group,and the difference was statistially significant（P<0. 05）. There was no statistically significant difference between the bilateral lung Dmean（P> 0. 05）. CardiacV20,V30,V40,and mean cardiac dose（Dmean） in the DIBH group were significantly lower than those in the control group（P<0. 05）. The differences in maximum spinal cord dose（Dmax）,mean dose（Dmean）,mean healthy breast dose between the two groups were no statistically significant difference（P> 0. 05）. In the DIBH group,there was a statistically significant difference in the volume of the left and right lungs after deep inspiration compared to before deep inspiration（P< 0. 05）.Conclusion:The application of DIBH technique in adjuvant radiotherapy of patients after breast-conserving surgery can improve the target volume dose and significantly reduce the irradiated dose to the heart,lungs and other organs at risk.更多还原