Study on thyroid radiation dose of two intensity-modulated radiotherapy plans after radical mastectomy of left breast cancer
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摘要:目的 分析左乳癌术后静态调强放疗（sIMRT）计划和容积旋转调强放疗（VMAT）计划的甲状腺受照剂量特点。方法 回顾性选取68例左乳癌根治术后放疗患者作为研究对象，应用Pinnacle3 10.0计划系统分别设计sIMRT计划和VMAT计划，在肿瘤靶区均归一到相同剂量指标的前提下，比较sIMRT计划和VMAT计划危及器官的受照剂量。结果 VMAT的左肺接受5 Gy辐射剂量体积（V5）和接受20 Gy辐射剂量体积（V20）、心脏接受30 Gy辐射剂量体积（V30）和平均辐射剂量（Dmean）均低于sIMRT，差异有统计学意义（P＜0.05）；sIMRT和VMAT的左侧甲状腺V5、接受10 Gy辐射剂量体积（V10）、V20基本达100.00%，差异无统计学意义（P＞0.05），但VMAT的左侧甲状腺V30、接受40 Gy辐射剂量体积（V40）、接受50 Gy辐射剂量体积（V50）和Dmean低于sIMRT，差异有统计学意义（P＜0.05）；VMAT的右侧甲状腺V20和Dmean低于sIMRT，差异有统计学意义（P＜0.05）。结论 sIMRT、VMAT技术均能满足临床要求，其中VMAT对甲状腺的保护作用显著优于sIMRT，且左侧甲状腺受照剂量较高、右侧甲状腺受照剂量较低，如何最大限度降低甲状腺受照剂量还需进一步研究。Abstract:Objective To analyze thyroid radiation dose of postoperative static intensity modulated radiation therapy (sIMRT) and volumetric intensity-modulated arc therapy(VMAT) for left breast cancer after left breast cancer surgery.Methods A total of 68 patients with radiotherapy after radical mastectomy of left breast cancer were retrospectively selected. The sIMRT and VMAT plans were designed using Pinnacle3 10.0 planning system, the dosages of organs at risk were compared between the two groups under the premise that the tumor target was normalized to the same dose.Results The percentage of volumes of the left lung exposed to radiation dose of 5 Gy(V5), 20 Gy(V20), percentage of volume of the heart exposed to radiation dose of 30 Gy(V30) of the heart, and mean radiation dose (Dmean) by VMAT were lower than those of the sIMRT(P < 0.05). V5 of left thyroid, exposed to radiation dose of 10 Gy(V10) and V20 of both plans basically reached 100.00%, but there were no statistical differences (P > 0.05), while V30, percentage of volume of left thyroid exposed to radiation dose of 40 Gy (V40), exposed to radiation dose of 50 Gy(V50) and Dmean of VMAT were significantly lower than sIMRT (P < 0.05); V20 of the right thyroid and Dmean of VMAT were significantly lower than those of sIMRT (P < 0.05).Conclusion Both of the two radiotherapy techniques can meet the clinical requirements. VMAT is superior to IMRT in thyroid protection and the radiation dose of the left thyroid is larger than that of the right thyroid. Further study is needed on how to minimize the thyroid exposure dose.
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表 1 不同放疗计划的左肺和心脏剂量学参数比较(x±s)
部位 参数 sIMRT(n=68) VMAT(n=68) 左肺 V5/% 66.20±2.82 63.10±1.71* V20/% 30.05±1.05 26.55±1.57* 心脏 V30/% 2.65±1.31 1.50±1.14* Dmean/cGy 796.31±125.52 726.43±123.34* sIMRT: 静态调强放疗; VMAT: 容积旋转调强放疗;
V5、V20、V30: 接受5、20、30 Gy辐射剂量体积;
Dmean: 平均辐射剂量。与sIMRT比较, * P＜0.05。
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表 2 不同放疗计划的甲状腺受照剂量比较(x±s)
部位 参数 sIMRT(n=68) VMAT(n=68) 左侧甲状腺 V5/% 100.00 100.00 V10/% 100.00 100.00 V20/% 100.00 99.40±2.04 V30/% 97.85±4.60 93.50±8.31* V40/% 82.00±13.04 72.85±19.38* V50/% 20.15±10.74 18.85±10.50* Dmean/cGy 4 488.05±189.35 4 339.20±291.67* 右侧甲状腺 V5/% 100.00 100.00 V10/% 99.50±2.29 99.15±3.80 V20/% 34.80±22.79 12.75±9.32* V30/% 0 0 Dmean/cGy 1 906.05±229.02 1 737.80±137.63* 全甲状腺 V30/% 47.45±7.54 43.40±7.56* Dmean/cGy 3 137.60±234.75 2 944.30±207.47* sIMRT: 静态调强放疗; VMAT: 容积旋转调强放疗;
V5、V10、V20、V30、V40、V50: 接受5、10、20、30、40、50 Gy辐射剂量体积;
Dmean: 平均辐射剂量。与sIMRT比较, * P＜0.05。
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[1] 中国医师协会放射肿瘤治疗医师分会. 乳腺癌放射治疗指南(中国医师协会2020版)[J]. 中华放射肿瘤学杂志, 2021, 30(4): 321-342. doi: 10.3760/cma.j.cn113030-20210107-00010 [2] 吉维, 刘梦岚, 黄爽, 等. 早期乳腺癌保乳术后不同放疗技术的研究进展[J]. 现代医学, 2020, 48(11): 1474-1477. doi: 10.3969/j.issn.1671-7562.2020.11.026 [3] 童薇, 郑杰, 沈学明, 等. 调强放射技术与切线野三维适形技术在乳腺癌保乳术后的应用价值[J]. 河北医学, 2020, 26(5): 778-784. doi: 10.3969/j.issn.1006-6233.2020.05.019 [4] 周湛明, 徐慆, 舒琦. 乳腺癌锁骨上区不同放疗技术甲状腺剂量学比较及其对生存期和淋巴细胞亚群的影响[J]. 中国医学物理学杂志, 2021, 38(2): 143-147. https://www.cnki.com.cn/Article/CJFDTOTAL-YXWZ202102003.htm [5] 迪丽努尔·尼加提, 雪克来提·库尔班, 杨娜, 等. 不同放疗方式对乳腺癌患者甲状腺血流动力学、甲状腺激素及疗效的影响[J]. 中国医师杂志, 2021, 23(1): 94-97. [6] 袁美芳, 赵彪, 杨毅, 等. 左乳癌根治术后sIMRT和VMAT靶区、左肺和心脏不同梯度的剂量学研究[J]. 临床医学研究与实践, 2019, 4(30): 122-123, 140. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201930052.htm [7] 赵红福, 韩东梅, 程光惠, 等. ICRU89号报告的解读——放射物理篇[J]. 中华放射肿瘤学杂志, 2019, 28(1): 74-77. https://d.wanfangdata.com.cn/periodical/zhfszl201901017 [8] ZHU M Y, WU H J, MIAO J J, et al. Radiation-induced hypothyroidism in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy with or without chemotherapy: Development of a nomogram based on the equivalent dose[J]. Oral Oncol, 2021, 120: 105378. doi: 10.1016/j.oraloncology.2021.105378
[9] 范洋玲, 张路. 适形调强放射治疗后鼻咽癌患者甲状腺功能减退的风险因素分析及控制[J]. 实用癌症杂志, 2021, 36(2): 260-264. https://www.cnki.com.cn/Article/CJFDTOTAL-SYAZ202102022.htm [10] 王哲雅, 张真稳. 不同疾病组成的自身免疫性多内分泌腺综合征Ⅱ型3例[J]. 实用临床医药杂志, 2021, 25(21): 111-113, 118. doi: 10.7619/jcmp.20211510 [11] 吴迎春, 吕康泰. 超声应变弹性成像在继发性甲状旁腺增生术前评估中的应用价值[J]. 实用临床医药杂志, 2021, 25(21): 107-110. doi: 10.7619/jcmp.20212353 [12] DARVISH L, GHORBANI M, TESHNIZI S H, et al. Evaluation of thyroid gland as an organ at risk after breast cancer radiotherapy: a systematic review and meta-analysis[J]. Clin Transl Oncol, 2018, 20(11): 1430-1438. http://www.onacademic.com/detail/journal_1000040380055810_3dbd.html
[13] KANYILMAZ G, AKTAN M, KOC M, et al. Radiation-induced hypothyroidism in patients with breast cancer: a retrospective analysis of 243 cases[J]. Med Dosim, 2017, 42(3): 190-196. http://www.onacademic.com/detail/journal_1000039909356510_0410.html
[14] TUNIO M A, AL ASIRI M, BAYOUMI Y, et al. Is thyroid gland an organ at risk in breast cancer patients treated with locoregional radiotherapy? Results of a pilot study[J]. J Cancer Res Ther, 2015, 11(4): 684-689. https://pubmed.ncbi.nlm.nih.gov/26881502/
[15] 王天昶, 张彦兵, 王锋刚, 等. 乳腺癌改良根治术后两种适形放疗计划的剂量学对比[J]. 实用医学杂志, 2015, 31(22): 3745-3747. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201522041.htm [16] 洪潮, 胡海芹, 袁星星, 等. 不同调强技术在左侧乳腺癌根治术后放疗中的剂量学分析[J]. 实用癌症杂志, 2018, 33(12): 2087-2088. https://www.cnki.com.cn/Article/CJFDTOTAL-SYAZ201812054.htm [17] 张明, 牛瑞军, 魏世鸿, 等. 乳腺癌锁骨上区IMRT和3D-CRT放疗技术甲状腺剂量学比较研究[J]. 中华肿瘤防治杂志, 2018, 25(7): 490-493, 498. https://www.cnki.com.cn/Article/CJFDTOTAL-QLZL201807008.htm [18] 杨健, 刘琦, 刘颖, 等. 左乳腺癌根治术后放疗动态调强和容积调强计划的剂量学对比[J]. 现代肿瘤医学, 2019, 27(15): 2758-2760. https://www.cnki.com.cn/Article/CJFDTOTAL-SXZL201915034.htm [19] 陈舒婷, 杨帅, 姜仁伟, 等. 乳腺癌根治术后IMRT和VMAT放疗技术剂量学研究[J]. 临床医学研究与实践, 2019, 4(9): 13-15. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201909006.htm -
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