| 一种改善乳腺癌锁骨上区与乳腺区域接野处剂量分布的保乳术后
放疗计划 |
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| 引用本文： | 毕苏艳,任骅,王越男.一种改善乳腺癌锁骨上区与乳腺区域接野处剂量分布的保乳术后
放疗计划[J].中国医学物理学杂志,2020,37(9):1095-1100. |
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| 作者姓名： | 毕苏艳 任骅 王越男 |
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| 作者单位： | 国家癌症中心/国家癌症研究中心/中国医学科学院肿瘤医院北京协和医学院肿瘤医院深圳医院，广东深圳518116 |
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| 摘 要： | 目的:介绍一种乳腺癌术后放疗计划设计方案，用于乳腺区与锁骨上区同时照射时，改善接野处剂量分布不均匀的
情况。方法:选取10例已完成治疗的乳腺癌病例，均需进行锁骨上区和乳腺区照射。常规设计方案包括锁骨上区设计3
野调强放疗计划和胸壁乳腺区设计混合调强计划。本研究保持常规计划设计方案不变，在乳腺区与锁骨上区的接野处采
用野中野设计方案，通过调节子野的叶片位置，形成剂量跌落梯度。比较两种方案计划的剂量学差异，靶区的剂量学参数
包括计划靶区（PTV）和PTV_J的Dmax、Dmin、均匀性指数（CI）和适形度指数（HI），PTV_J为接野处沿头脚方向2 cm勾画的
PTV的体积。危及器官的剂量学参数包括患侧肺的V5、V20、V30和Dmean，心脏的Dmean，健侧乳腺的V20和Dmean以及脊髓的
Dmax。结果:和常规设计方案相比，改良后设计方案接野处的CI和HI得到明显改善（P<0.05），整体靶区的CI和HI比较无
明显差别（P>0.05），危及器官的剂量学比较无明显差异（P>0.05）。结论:改良的设计方案能在不影响其他结构的剂量分
布情况下明显改善接野处剂量分布，可用于临床乳腺癌放疗。
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| 关 键 词： | 乳腺癌 调强放疗 乳腺区域 锁骨上区域 剂量学 |
A radiotherapy plan following breast-conserving surgery for improving the dose distribution at
the junction region between supra-clavicular fossa region and breast region |
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| BI Suyan,REN Hua,WANG Yuenan.A radiotherapy plan following breast-conserving surgery for improving the dose distribution at
the junction region between supra-clavicular fossa region and breast region[J].Chinese Journal of Medical Physics,2020,37(9):1095-1100. |
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| Authors: | BI Suyan REN Hua WANG Yuenan |
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| Affiliation: | National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital，Chinese Academy of
Medical Sciences and Peking Union Medical College, Shenzhen 518116, China |
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| Abstract: | Objective To introduce a modified radiotherapy plan after breast-conserving surgery for improving the uniformity of
dose distribution at the junction region between supra-clavicular fossa (SC) region and breast region. Methods Ten patients who
underwent treatment and required both SC irradiation and breast irradiation were selected for the study. Conventional plan included
3-field intensity-modulated radiotherapy (IMRT) on SC region and hybrid IMRT on breast region. The plans of 10 patients were
re-planned using the proposed method.With 3-field IMRT on SC region, field-in-field technique was applied on tangential breast
fields for creating a dose gradient at the junction region by adjusting the position of mutli-leaf collimator leaves. The dosimetric
differences between two plans were compared. The dosimetric indicators of target areas included the Dmax, Dmin, conformity index
(CI) and homogeneity index (HI) of PTV and PTV_J. PTV_J was defined as the volume of the junction region, which was 1 cm
cranial and 1 cm caudal to the iso-center in PTV. The dosimetric indicators of organs-at-risk included the V5, V20, V30, Dmean of the
affected lung, the Dmean of the heart, the V20, Dmean of the contralateral breast and the Dmax of spinal cord. Results The CI and HI
of PTV_J in modified plan were superior to those in conventional plan (P<0.05). However, there was no significant difference
in the CI and HI of PTV and the dosimetric indicators of organs-at-risk (all P>0.05). Conclusion The modified plan which can
improve the dose distribution at the junction region, without affecting the doses of target areas and organs-at-risk, can be applied
into the radiotherapy for breast cancer. |
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| Keywords: | breast cancer intensity-modulated radiotherapy breast region supra-clavicular fossa region dosimetry |
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