左侧乳腺癌保乳术后基于靶区内缘切线野dIMRT剂量优化策略的研究

doi:10.3760/cma.j.cn371439-20250507-00118

国际肿瘤学杂志 ›› 2025, Vol. 52 ›› Issue (11): 689-694.doi: 10.3760/cma.j.cn371439-20250507-00118

左侧乳腺癌保乳术后基于靶区内缘切线野dIMRT剂量优化策略的研究

赵彪¹, 朱俞朴¹, 张雅婷¹, 袁美芳¹, 李瀚¹, 杨毅¹, 孙朝细²()

¹昆明医科大学第三附属医院云南省肿瘤医院北京大学肿瘤医院云南医院放射治疗科，昆明 650118
²昆明医科大学第三附属医院云南省肿瘤医院北京大学肿瘤医院云南医院重症医学科，昆明 650118

收稿日期:2025-05-07 修回日期:2025-07-06 出版日期:2025-11-08 发布日期:2025-12-21
通讯作者: 孙朝细 E-mail:sunchaoxi1201@126.com
基金资助:
国家自然科学基金(32360114)

Study on dose optimization strategy of dynamic intensity-modulated radiotherapy based on the inner edge tangent field for the target area after breast-conserving surgery for left-sided breast cancer

Zhao Biao¹, Zhu Yupu¹, Zhang Yating¹, Yuan Meifang¹, Li Han¹, Yang Yi¹, Sun Chaoxi²()

¹Department of Radiotherapy， Third Affiliated Hospital of Kunming Medical University， Yunnan Cancer Hospital， Peking University Cancer Hospital Yunnan， Kunming 650118， China
²Department of Critical Care Medicine， Third Affiliated Hospital of Kunming Medical University， Yunnan Cancer Hospital， Peking University Cancer Hospital Yunnan， Kunming 650118， China

Received:2025-05-07 Revised:2025-07-06 Online:2025-11-08 Published:2025-12-21
Contact: Sun Chaoxi E-mail:sunchaoxi1201@126.com
Supported by:
National Natural Science Foundation of China(32360114)

摘要/Abstract

摘要：

目的探究左侧乳腺癌保乳术后基于靶区内缘切线野（IETF）动态调强放疗（dIMRT）的剂量优化策略。方法回顾性选取2023年8月至2024年10月收治于云南省肿瘤医院放疗科的36例左侧乳腺癌保乳术后放疗患者的定位CT和靶区危及器官（OAR）等资料，为每例患者分别设计常规切线野（CTF）和基于靶区IETF两种dIMRT计划（CTF-dIMRT和IETF-dIMRT）；统计两种计划的靶区剂量和OAR剂量并进行数据分析。结果 CTF-dIMRT和IETF-dIMRT两种放疗计划靶区的D_98%分别为（47.36±0.88）、（47.61±0.81） Gy，D_50%分别为（52.08±0.23）、（52.01±0.22） Gy，适形指数（CI）分别为0.82±0.03、0.84±0.03，差异均有统计学意义（t=-3.45，P=0.001；t=2.28，P=0.029；t=-6.24，P<0.001）；D_2%分别为（53.83±0.33）、（53.89±0.42）Gy，均匀性指数（HI）分别为0.12±0.02、0.12±0.02，差异均无统计学意义（t=-1.11，P=0.276；t=1.89，P=0.067）。CTF-dIMRT和IETF-dIMRT两种放疗计划左肺V₅分别为（35.40±7.77）%、（31.44±6.01）%，V₂₀分别为（12.69±2.84）%、（11.48±2.22）%，D_mean分别为（8.15±1.42）、（7.39±1.13） Gy，差异均有统计学意义（t=6.92，P<0.001；t=6.79，P<0.001；t=9.10，P<0.001）；心脏D_mean分别为（4.99±1.15）、（4.29±1.00） Gy，右肺D_mean分别为（1.24±0.12）、（1.15±0.11） Gy，右乳D_mean分别为（2.34±1.01）、（3.26±1.54） Gy，脊髓D₂分别为（1.26±0.13）、（1.22±0.12） Gy，差异均有统计学意义（t=7.88，P<0.001；t=6.66，P<0.001；t=-6.85，P<0.001；t=2.76，P=0.009）。结论 IETF-dIMRT和CTF-dIMRT两种计划均能充分满足临床要求，相较于CTF-dIMRT，左侧乳腺癌保乳术后IETF-dIMRT在靶区剂量和OAR保护方面均有更多的获益。

关键词: 单侧乳腺肿瘤, 放射疗法，调强适形, 辐射剂量, 常规切线野, 内缘切线野

Abstract:

Objective To explore the dose optimization strategy of dynamic intensity-modulated radiotherapy （dIMRT） based on the inner edge tangential field （IETF） for the target area after breast-conserving surgery for left-sided breast cancer. Methods The localization CT and target organ at risk （OAR） data of 36 patients with left-sided breast cancer treated with breast-conserving surgery and postoperative radiotherapy in the Department of Radiotherapy of Yunnan Cancer Hospital from August 2023 to October 2024 were retrospectively selected. Two dIMRT schedules， conventional tangential field （CTF）-dIMRT and IETF-dIMRT， were designed for each patient； The target dose and the OAR dose of the two groups were counted and analyzed. Results For CTF-dIMRT and IETF-dIMRT， the D_98% of the target area were （47.36±0.88） and （47.61±0.81） Gy， and the D_50% were （52.08±0.23） and （52.01±0.22） Gy， the conformity index （CI） were 0.82±0.03 and 0.84±0.03， with statistically significant differences （t=-3.45， P=0.001； t=2.28， P=0.029； t=-6.24， P<0.001）. The D_2% were （53.83±0.33） and （53.89±0.42） Gy， the homogeneity index （HI） were 0.12±0.02 and 0.12±0.02， with no statistically significant difference （t=-1.11， P=0.276； t=1.89， P=0.067）. For CTF-dIMRT and IETF-dIMRT， the V₅ of left lung were （35.40±7.77） % and （31.44±6.01） %， the V₂₀ were （12.69±2.84） % and （11.48±2.22） %， the D_mean were （8.15±1.42） and （7.39±1.13） Gy， with statistically significant differences （t=6.92， P<0.001； t=6.79， P<0.001； t=9.10， P<0.001）. The heart D_mean were （4.99±1.15） and （4.29±1.00） Gy， the right lung D_mean were （1.24±0.12） and （1.15±0.11） Gy， the right breast D_meanwere （2.34±1.01） and （3.26±1.54） Gy， the spinal cord D₂ were （1.26±0.13） and （1.22±0.12） Gy， with statistically significant differences （t=7.88， P<0.001； t=6.66， P<0.001； t=-6.85， P<0.001； t=2.76， P=0.009）. Conclusions Both IETF-dIMRT and CTF-dIMRT can fully meet clinical requirements. Compared with CTF-dIMRT， IETF-dIMRT after breast-conserving surgery for left-sided breast cancer has more benefits in terms of target dose and OAR protection.

Key words: Unilateral breast neoplasms, Radiotherapy， intensity-modulated, Radiation dosage, Conventional tangential field, Inner edge tangential field

赵彪, 朱俞朴, 张雅婷, 袁美芳, 李瀚, 杨毅, 孙朝细. 左侧乳腺癌保乳术后基于靶区内缘切线野dIMRT剂量优化策略的研究[J]. 国际肿瘤学杂志, 2025, 52(11): 689-694.

Zhao Biao, Zhu Yupu, Zhang Yating, Yuan Meifang, Li Han, Yang Yi, Sun Chaoxi. Study on dose optimization strategy of dynamic intensity-modulated radiotherapy based on the inner edge tangent field for the target area after breast-conserving surgery for left-sided breast cancer[J]. Journal of International Oncology, 2025, 52(11): 689-694.

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左侧乳腺癌保乳术后基于靶区内缘切线野dIMRT剂量优化策略的研究

Study on dose optimization strategy of dynamic intensity-modulated radiotherapy based on the inner edge tangent field for the target area after breast-conserving surgery for left-sided breast cancer

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参数	CTF-dIMRT	IETF-dIMRT	t值	P值
D_98%（Gy）	47.36±0.88	47.61±0.81	-3.45	0.001
D_50%（Gy）	52.08±0.23	52.01±0.22	2.28	0.029
D_2%（Gy）	53.83±0.33	53.89±0.42	-1.11	0.276
CI	0.82±0.03	0.84±0.03	-6.24	<0.001
HI	0.12±0.02	0.12±0.02	1.89	0.067

参数	CTF-dIMRT	IETF-dIMRT	t值	P值
左肺
V₅（%）	35.40±7.77	31.44±6.01	6.92	<0.001
V₂₀（%）	12.69±2.84	11.48±2.22	6.79	<0.001
D_mean（Gy）	8.15±1.42	7.39±1.13	9.10	<0.001
心脏
D_mean（Gy）	4.99±1.15	4.29±1.00	7.88	<0.001
右肺
D_mean（Gy）	1.24±0.12	1.15±0.11	6.66	<0.001
右乳
D_mean（Gy）	2.34±1.01	3.26±1.54	-6.85	<0.001
脊髓
D_2%（Gy）	1.26±0.13	1.22±0.12	2.76	0.009

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