国际肿瘤学杂志

国际肿瘤学杂志 ›› 2025, Vol. 52 ›› Issue (7): 448-454.doi: 10.3760/cma.j.cn371439-20250217-00078

• 质子放疗剂量学特点 • 上一篇    下一篇

乳腺癌4例质子放疗剂量学特点分析

李成强1,2, 王云刚1,2, 余以珊3, 吴仕章1,2, 陶城1,2, 马星民1,2, 戴天缘1,2, 段敬豪1,2, 陈进琥1,2, 白曈1,2, 朱健1,2()   

  1. 1山东省肿瘤防治研究院（山东省肿瘤医院）放射物理技术科，山东第一医科大学（山东省医学科学院），济南 250117
    2山东省医药卫生儿童肿瘤精确放疗重点实验室（山东省肿瘤医院），济南 250117
    3山东省肿瘤防治研究院（山东省肿瘤医院）胸部放疗三病区，山东第一医科大学（山东省医学科学院），济南 250117
  • 收稿日期:2025-02-17 修回日期:2025-05-19 出版日期:2025-07-08 发布日期:2025-07-23
  • 通讯作者: 朱健 E-mail:zhujian@sdfmu.edu.cn
  • 基金资助:
    国家科技重大专项(2024ZD0519901);国家自然科学基金(12105160);国家自然科学基金(82172072);山东省重点研发计划(2024CXPT084);山东省自然科学基金(ZR2021QA099);山东省自然科学基金(ZR2022QH188);山东省高等学校青年创新团队发展计划(2024KJJ013);山东省青年科技人才托举工程(SDAST2024QTB034)

Analysis of dosimetric characteristics of proton radiotherapy in 4 cases of breast cancer

Li Chengqiang1,2, Wang Yungang1,2, Yu Yishan3, Wu Shizhang1,2, Tao Cheng1,2, Ma Xingmin1,2, Dai Tianyuan1,2, Duan Jinghao1,2, Chen Jinhu1,2, Bai Tong1,2, Zhu Jian1,2()   

  1. 1Department of Radiation Oncology Physics，Shandong Cancer Hospital and Institute，Shandong First Medical University and Shandong Academy of Medical Sciences，Jinan 250117，China
    2Shandong Provincial Key Medical and Health Laboratory of Pediatric Cancer Precision Radiotherapy （Shandong Cancer Hospital），Jinan 250117，China
    3Department of Radiation Oncology （Chest Section 3），Shandong Cancer Hospital and Institute，Shandong First Medical University and Shandong Academy of Medical Sciences，Jinan 250117，China
  • Received:2025-02-17 Revised:2025-05-19 Online:2025-07-08 Published:2025-07-23
  • Contact: Zhu Jian E-mail:zhujian@sdfmu.edu.cn
  • Supported by:
    National Science and Technology Major Project of China(2024ZD0519901);National Natural Science Foundation of China(12105160);National Natural Science Foundation of China(82172072);Key R&D Program of Shandong Province，China(2024CXPT084);Natural Science Foundation of Shandong Province of China(ZR2021QA099);Natural Science Foundation of Shandong Province of China(ZR2022QH188);Youth Innovation Team Development Plan of Shandong Universities(2024KJJ013);Shandong Provincial Young Science and Technology Talent Support Project(SDAST2024QTB034)

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摘要：

目的 探索质子放疗和光子放疗应用于乳腺癌治疗的剂量学特点。方法 选取2024年1月至2024年5月在山东省肿瘤防治研究院（山东省肿瘤医院）需行放疗的4例女性乳腺癌患者为研究对象，靶区范围分别为左侧胸壁加左侧锁骨上下淋巴引流区、左侧胸壁加左侧内乳、锁骨上下淋巴引流区、右侧胸壁加右侧内乳、锁骨上下淋巴引流区和双乳腺并瘤床加量。根据靶区处方剂量和危及器官限量要求，分别设计质子调强放疗（IMPT）、光子固定野调强放疗（IMRT）（双侧乳腺为螺旋断层放疗）计划。评估各计划靶区的适形指数（CI）、均匀性指数（HI）、梯度指数（GI）及危及器官受量，对比IMPT和光子放疗的剂量学特点。结果 4例乳腺癌患者的IMPT和光子放疗计划均能满足临床要求，其中IMPT计划HI值（0.10~0.14）与光子放疗计划（0.10~0.12）相当，光子放疗计划的平均CI较IMPT计划高0.10，平均GI较IMPT计划低0.55。IMPT计划的患侧肺和心脏的Dmean更低，特别在低剂量区域（V0-3）显著少于光子放疗计划；患侧肺的Dmean分别降低了12.2%、6.1%、16.1%和34.8%，心脏的Dmean分别降低了47.2%、57.0%、72.4%和83.0%。IMPT计划的患侧肺V20并不比光子放疗计划更低（单侧乳腺：IMPT为30.0%~34.0%，IMRT为29.0%~35.9%）。结论 IMPT在保证乳腺癌靶区覆盖的情况下显著降低了患侧肺和心脏的Dmean，使更多区域不受照射、保护周边更多的正常组织。但是在患侧肺的V20方面，IMPT并未表现出比光子放疗计划更有优势。

关键词: 乳腺肿瘤, 放射疗法, 质子疗法, 放射治疗剂量

Abstract:

Objective To explore the dosimetric characteristics of proton and photon radiotherapy in the treatment of breast cancer. Methods Four female breast cancer patients who needed radiotherapy at Shandong Cancer Hospital and Institute from January 2024 to May 2024 were selected as the research subjects. The target area ranges of 4 patients were left-sided breast cancer with lymph node involvement，left-sided breast cancer with lymph node involvement and internal mammary node，right-sided breast cancer with lymph node involvement and internal mammary node and synchronous bilateral breast cancer. Intensity modulated proton therapy （IMPT） and intensity modulated radiation therapy （IMRT） plans were designed respectively based on the prescribed dose in the target area and the limits of organs at risk （tomotherapy plan for bilateral breasts）. The conformity index （CI），homogeneity index （HI），gradient index （GI） and organs at risk doses were evaluated. The dosimetric characteristics of IMPT and photon radiotherapy were compared. Results Both IMPT and photon radiotherapy plans of the 4 breast cancer cases met the clinical dose requirements. The HI value of IMPT plans （0.10-0.14） was comparable to that of photon radiotherapy plans （0.10-0.12），and the average CI of the photon radiotherapy plans was 0.10 higher than that of the IMPT plans，and the average GI was 0.55 lower than that of the IMPT plans. The Dmean of ipsilateral lung and heart of IMPT was lower，especially in the low-dose area （V0-3），which was significantly lower than the photon radiotherapy plans，Dmean of ipsilateral lung was reduced by 12.2%，6.1%，16.1% and 34.8%，respectively，Dmean of heart was reduced by 47.2%，57.0%，72.4% and 83.0%，respectively. The ipsilateral lung V20 of IMPT was not lower than photon radiotherapy plans （unilateral breast： IMPT was 30.0%-34.0%，IMRT was 29.0%-35.9%）. Conclusions IMPT significantly reduces the Dmean to the ipsilateral lung and heart while ensuring dose coverage of the target in breast cancer，preventing more volume of surrounding normal tissues from being irradiated. However，IMPT does not show much more advantage than photon radiotherapy plans in the ipsilateral lung V20.

Key words: Breast neoplasms, Radiotherapy, Proton therapy, Radiotherapy dosage