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目的:分析比较乳腺癌术后胸壁辅助放疗采用容积弧形调强技术与传统的胸壁切线野的剂量学差异。方法:随机选择需要放射治疗的乳腺癌患者10例,左右侧各5例,采用Eclipse计划系统为每位患者分别设计传统的胸壁切线野与容积弧形调强两套放射治疗计划,处方剂量均为DT50Gy/25次。用剂量体积直方图(DVH)比较靶区、心脏和肺受照射剂量和体积等参数的差异。结果:2种技术均能满足胸壁靶区剂量分布要求。与常规切线野相比,容积弧形调强技术使左侧乳腺癌患者的心脏平均V30由15.87%减少到1.58%(P=0.00),心脏平均V10由22.41%增加到37.82%(P=0.00);左肺平均V20由25.72%减少到11.35%(P=0.00),左肺平均V30由22.79%减少到4.23%(P=0.00)。右侧乳腺癌患者右肺平均V20由28.23%减少到13.55%(P=0.00),右肺平均V30由25.31%减少到5.77%(P=0.00),右肺平均V10由33.26%增加到42.08%(P=0.01)。无论左、右侧乳腺癌,容积弧形调强技术对于身体的低剂量照射范围均大于传统切线野。结论:乳腺癌术后胸壁辅助放疗采用容积弧形调强技术相对于传统的胸壁切线野,能明显减少心脏和肺的高剂量受照体积,却增加了低剂量区范围。
OBJECTIVE: To compare the dosimetric differences between chest wall radiotherapy with chest wall radiotherapy and chest wall radiotherapy for breast cancer. Methods: Ten patients with breast cancer requiring radiotherapy were randomly selected. Five patients on the right and left sides were selected. Two sets of radiotherapy plans of chest wall tangential field and volume arc intensity were designed respectively by using Eclipse planning system. The prescription dose For DT50Gy / 25 times. Dose volume histogram (DVH) was used to compare the difference of dose, volume and other parameters between target area, heart and lung. Results: Both of the two techniques could meet the requirement of dose distribution in the target area of chest wall. Compared with the conventional tangential field, the volumetric arc intensity modulation reduced the average heart V30 of left breast cancer patients from 15.87% to 1.58% (P = 0.00) and the average heart V10 increased from 22.41% to 37.82% (P = 0.00 ); Mean V20 decreased from 25.72% to 11.35% (P = 0.00) in the left lung, and decreased from 22.79% to 4.23% in the left lung (P = 0.00). The average right V20 decreased from 28.23% to 13.55% (P = 0.00) in the right breast cancer patients and from 25.31% to 5.77% (P = 0.00) in the right lung, and from 33.26% to 42.08% in the right lung (P = 0.01). Regardless of left and right breast cancer, volume arc intensity modulation technology for the body’s low-dose irradiation range is greater than the traditional tangent field. CONCLUSION: Compared with the traditional chest wall tangential field, chest wall radiotherapy for breast cancer with chest radiotherapy can significantly reduce the volume of high dose of heart and lungs, but increase the range of low dose.