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时间:2019-10-08
《乳腺癌改良根治术后胸壁和区域淋巴引流区整体化调强放疗剂量学与不良反应分析》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、万方数据生堡越魁艘擅堂苤壶垫!!至!旦筮!!鲞筮!翅£!i!』曼型鱼虫!!!:』塑!垒型垫!!:!!!:!!:盟!:!乳腺癌改良根治术后胸壁和区域淋巴引流区整体化调强放疗剂量学与不良反应分析马金利李炯雁朱传营陈剑曹璐谢耩蔡钢俞晓立章真郭小毛陈佳艺【摘要】目的探讨乳腺痛改良根治术后胸壁和区域淋巴引流区整体化调强放疗(IMRT)技术的剂量学特点,并观察照射后的急性不良反应。方法对75例乳腺癌患者(左侧乳腺癌4l例)以治疗位行计划CT扫描,在CT上将胸壁和锁骨上淋巴引流区加或不加内乳区作为整体勾画。针对整个靶区铬体或分段设计IMRT计划。处方剂量50Gy至少包绕90%计
2、划靶体积(P1'V),PrV包含内乳区者3l例。用靶区和正常组织体积一剂量评价治疗计划,并观察计划实施后的急件不良反应。整体计划与分段计划的剂量学参数比较行成组t检验。结果伞组患者均完成计划设计和放疗,PrV适形指数、均匀指数分别为1.43、0.14,刚包含内乳区者均匀指数较高,110%处方剂链刚体积均<5%,正常组织实际剂昔均未超出限值。整体计划(55例)与分段计划(20例)比较,其D一、D。一、V107%和V110%均不同(t=2.19~2.53,P=0.013~0.031)。32例发生1>2级皮炎,其中2级22例、3级10例;发生部位以腋窝前皱褶最为常见,多
3、数发生于放疗后1—2周。仪2例发生2级肺炎。结论胸壁和Ⅸ域淋巴引流区整体化IMRT技术剂昔学上町行,急性不良反应多数患者叮耐受。【关键词】乳腺肿瘤/外科学;乳腺肿瘤/放射疗法;剂量学;急性不良反应IrradiationofthechestwalIandregionalnodesasanintegratedvolumewithIMRTforbreastcanceraftermastectomy:fromdosimetrytoclinicalside·effectsMAJin—li,12Jiong—yan。zHUChll,an-ring。CHENJian.CAOLu,
4、XIEJiang,CAlGang,FlYXiao·li。zHANGZhen,GUOXiao—rnao,CHENJia—yi.DepartmentofRadiationOncology,CancerHospitalofFudanUnivers毋;DepartmentofOncology,ShanghaiMedicalCollegeofFudanUniversity:Shanghai200032,c^inaCorrespondingauthor:CHENJia—yi,Email:chenjiayi0188@yahoo.com.cn【Abstract】0bjective
5、Todiscussdosimetriecharacteristicsofallintensity.modulatedradiotherapy(IMRT)techniquefortreatingthechestwallandregionalnodesasanintegratedvolumeaftermodifiedradieaJmastectomy(MRM).andobserveacuteside.effectsfollowingjrradiation.MethodsFromJune2009toAugust20lO.75patientswererandomlyenr
6、olled.Ofthese.4lhadleft-sidedbreastcancer.EacheligiblepatienthadaplanningCTintreatmentposition。onwhichthechestwalI,supraelavicular,andinfraclavicularnodes.+/.internalmammaryregion.werecontouredasanintegratedvolume.Amulti-beamIMR7rplanwasdesignedwiththetargeteitherasawholeortwosegments
7、dividedatbelowtheclaviclehead.Adoseof50Gvin25fractionswasprescribedtocoveratleast90%ofthePrrV.Internalmammaryregionwasincludedin3lcases.DosevolumehistogramswereusedtoevaluatetheIMRTplans.TheacutesideeffectswerefolloweduDregularlyduringandafterirradiation.Theindependenttwo.samplet-test
8、wasus
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