文章摘要
龙腾飞,闻妹,马涛,等.左侧乳腺癌保乳术后质子与光子放疗剂量学对比研究[J].中国临床保健杂志,2024,27(3):381-386.
左侧乳腺癌保乳术后质子与光子放疗剂量学对比研究
Comparative study of dosimetry between proton and photon radiotherapy after breast conserving surgery for left breast cancer
投稿时间：2024-04-09  
DOI：10.3969/J.issn.1672-6790.2024.03.022
中文关键词: 乳腺肿瘤  质子疗法  光子疗法  放射治疗剂量
英文关键词: Breast neoplasms  Proton therapy  Photons therapy  Radiotherapy dosage 〖FL
基金项目:
作者单位E-mail
龙腾飞 中国科学技术大学附属第一医院离子医学中心合肥离子医学中心放疗科,合肥 230088 longtengfei@himc.org.cn 
闻妹 中国科学技术大学附属第一医院离子医学中心合肥离子医学中心放疗科,合肥 230088  
马涛 中国科学技术大学附属第一医院离子医学中心合肥离子医学中心放疗科,合肥 230088  
刘鹤飞 中国科学技术大学附属第一医院离子医学中心合肥离子医学中心放疗科,合肥 230088  
柳璐 中国科学技术大学附属第一医院离子医学中心合肥离子医学中心放疗科,合肥 230088  
李骁扬 中国科学技术大学附属第一医院安徽省立医院放疗科  
张红雁 中国科学技术大学附属第一医院安徽省立医院放疗科 zhanghongyanahsl@fsyy.ustc.edu.cn 
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中文摘要:
      目的 比较在深吸气屏气呼吸模式(DIBH)下左侧乳腺癌保乳术后光子调强放疗(IMRT)、质子调强放疗(IMPT)剂量学差异。方法 选取2020年11月至2022年5月中国科学技术大学附属第一医院离子医学中心(合肥离子医学中心)在DIBH模式下接受左侧乳腺癌保乳术后放疗的7例女性患者病历资料,计划靶区(PTV)处方剂量均为50 Gy(5周,25次),对于影像学(包括功能性影像)上高度怀疑有残留或复发病灶的区域局部加量至PTVboost:60 Gy。分别在瓦里安Eclipse 15.5计划系统上设计IMRT计划和Eclipse 16.1计划系统上设计IMPT计划。对2组计划靶区剂量分布、适形指数(CI)、均匀性指数(HI)、两侧肺、健侧乳腺(右乳)、心脏及左冠状动脉前降支(LAD)照射剂量进行统计分析。结果 质子与光子放疗计划相比,PTV最大剂量(Dmax)(P=0.389)和平均剂量(Dmean)(P=0.044)、PTVboost Dmax(P=0.226)和Dmean(P=0.018)、CI(P=0.035)和HI(P=0.419)、患侧肺部(左侧)Dmax(P=0.153)、健侧肺(右肺)Dmax(P=0.318)和Dmean(P=0.046)、心脏Dmax(P=0.014)、LAD Dmax(P=0.025)、健侧乳腺(右乳)Dmax(P=0.097)均和光子计划无差异。但质子计划左侧肺Dmean(P＜0.01)、V5(P<0.001)、V20(P<0.001)及心脏Dmean(P<0.001)、LAD Dmean(P<0.001)、健侧乳腺(右乳)Dmean (P=0.010)均明显低于光子计划。结论 DIBH下左侧乳腺癌保乳术后质子和光子计划均满足临床要求。但采用质子放疗可显著降低对心脏及其亚单位、患侧肺和健侧乳腺的照射剂量。
英文摘要:
      Objective To compare photon-modulated radiation therapy (IMRT) and proton-modulated radiation therapy (IMPT) after breast-conserving surgery for left breast cancer under deep inspiratory breath-hold (DIBH) dosimetry differences.Methods A total of 7 female patients who received postoperative radiotherapy for left breast cancer in DIBH mode from November 2020 to May 2020 at the First Affiliated Hospital of USTC(Hefei Ion Medical Center) were selected.The planing target volume (PTV) was prescribed at 50 Gy (5 weeks,25 times),and the local dose was increased to PTVboost:60 Gy for areas with high imaging (including functional imaging) suspicion of residual or recurrent lesions.The IMRT plan was designed on the Varian Eclipse 15.5 plan system and the IMPT plan was designed on the Eclipse 16.1 plan system,respectively.The dose distribution,conformal index (CI),homogeneity index (HI),bilateral lungs,healthy breast gland (right breast),heart and left anterior descending coronary artery (LAD) of the two groups of planned targets were analyzed statistically.Results Proton versus photon radiation,the maximum dose(Dmax) of PTV (P=0.389) and the mean dose (Dmean)(P=0.044),Dmax of PTVboost (P=0.226) and Dmean (P=0.018),CI (P=0.035) and HI (P=0.419),Dmax of affected lung (left lung) (P=0.153),Dmax of healthy lung (right lung) (P=0.318) and Dmean(P=0.046),Dmax of heart (P=0.014),Dmax of LAD (P=0.025) and Dmax of healthy side breast (right breast) Dmax (P=0.097) were all the same as those in the photon program.However,the left lung Dmean(P＜0.01),V5(P<0.001),V20(P<0.001) of the affected side (left lung) of the proton program;Dmean of heart (P<0.001);Dmean of LAD(P<0.001);Dmean of healthy side breast (right breast)(P=0.010) were significantly lower than those of the photon program.Conclusions Both proton and photon programs after breast-conserving surgery for left breast cancer under DIBH meet clinical requirements.However,proton radiotherapy can significantly reduce the irradiation dose to the heart and its subunits,the affected lung and the healthy breast.
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