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| 基于解剖特征的左乳癌放疗心脏剂量学分析：3D-CRT、IMRT与VMAT技术比较 |
| Anatomy-Based Cardiac Dosimetric Analysis in Left-Sided Breast Cancer: Comparison of 3D-CRT, IMRT and VMAT |
| 投稿时间：2025-08-08 修订日期：2025-09-25 |
| DOI： |
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| 中文关键词: 乳腺癌，心脏保护，容积调强放疗，左前降支冠状动脉，剂量学分析，解剖因素 |
| 英文关键词:Breast cancer, Cardioprotection, Volumetric modulated arc therapy, Left anterior descending coronary artery, Dosimetric analysis, Anatomical factors |
| 基金项目: |
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| 摘要点击次数: 83 |
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| 中文摘要: |
| [目的] 本研究旨在比较3D适形放疗（3D-CRT）、调强放疗（IMRT）和容积调强放疗（VMAT）三种技术在乳腺癌术后放疗中的心脏剂量学差异，重点评估其对左前降支冠状动脉（LAD）的剂量学影响，为临床优选放疗方案提供依据。[方法] 研究共纳入20例左侧乳腺癌保乳术后患者。基于每位患者的CT定位图像，分别制定3D-CRT（切线野技术）、IMRT（7野均分方案）和VMAT（双弧旋转照射）三种放疗计划。评估心脏平均剂量（Dmean）、心脏V20和LAD_V40等关键剂量参数，并分析其与PTV-心脏距离、心脏体积等解剖因素的相关性。采用Kruskal-Wallis检验进行组间比较，分类变量比较使用卡方检验，相关性分析采用Spearman方法。[结果] VMAT在心脏保护方面显著优于其他两组（p<0.001）：心脏Dmean中位数为3.49 Gy，较3D-CRT（4.56 Gy）降低23.5%；心脏V20为1.13%，较3D-CRT（4.05%）降低72.1%；LAD_V40降至0，显著低于3D-CRT的39%和IMRT的5%（p<0.001）。VMAT组所有病例LAD_V40均满足临床指南要求（达标率100%），而3D-CRT和IMRT组达标率仅分别为5%和75%。相关性分析显示，PTV-心脏距离与LAD_V40呈负相关（r=-0.46至-0.57，p<0.05），当距离<6 mm时，3D-CRT的LAD_V40超标率达85%以上。[结论] VMAT技术可显著降低心脏及LAD的受照剂量，尤其PTV-心脏距离较近时优势更为明显。PTV-心脏距离是影响LAD受照剂量的重要解剖因素，可作为个体化放疗技术选择的参考依据。 |
| 英文摘要: |
| Objective This study aimed to compare the cardiac dosimetric differences among three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT) in post-operative radiotherapy for breast cancer, with a focus on the dosimetric impact on the left anterior descending coronary artery (LAD), so as to provide evidence for optimal clinical radiotherapy strategy selection. Methods A total of 20 patients who underwent breast-conserving surgery for left-sided breast cancer were enrolled. Based on each patient"s CT simulation images, three radiotherapy plans were designed: 3D-CRT (tangential field technique), IMRT (7-field equispaced plan), and VMAT (dual-arc rotation irradiation). Key dosimetric parameters including heart mean dose (Dmean), heart V20, and LAD_V40 were evaluated, and their correlations with anatomical factors such as the heart-to-PTV distance and heart volume were analyzed. The Kruskal–Wallis test was used for group comparisons, the chi-square test for categorical variables, and Spearman’s method for correlation analysis. Results VMAT was significantly superior to the other two techniques in cardiac protection (p < 0.001): the median heart Dmean was 3.49 Gy, which was 23.5% lower than that of 3D-CRT (4.56 Gy); the heart V20 was 1.13%, reduced by 72.1% compared with 3D-CRT (4.05%); and the LAD_V40 decreased to 0, significantly lower than that of 3D-CRT (39%) and IMRT (5%) (p < 0.001). All cases in the VMAT group met clinical guideline constraints for LAD_V40 (compliance rate 100%), whereas the compliance rates were only 5% and 75% in the 3D-CRT and IMRT groups, respectively. Correlation analysis revealed a negative correlation between heart-to-PTV distance and LAD_V40 (r = -0.46 to -0.57, p < 0.05). When the distance was less than 6 mm, the non-compliance rate of LAD_V40 in the 3D-CRT group exceeded 85%. Conclusion VMAT significantly reduces the radiation dose to the heart and LAD, demonstrating particular advantage when the heart-to-PTV distance is short. The heart-to-PTV distance is an important anatomical factor influencing LAD radiation exposure and may serve as a practical reference for individualized selection of radiotherapy techniques. |
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