| 王 勇,陈卫军,倪玲琴.乳腺癌保乳术后患者因素对调强放疗计划设计的影响分析 (此文经查为一稿多投，本刊作撤稿处理。《肿瘤学杂志》编辑部2018-6-26）[J].肿瘤学杂志,2018,24(5):465-469. |
| 乳腺癌保乳术后患者因素对调强放疗计划设计的影响分析 (此文经查为一稿多投，本刊作撤稿处理。《肿瘤学杂志》编辑部2018-6-26） |
| Effects of Patient Factors on Design of Intensity-Modulated Radiotherapy Plans after Breast Conservative Surgery |
| 投稿时间：2017-09-05 |
| DOI：10.11735/j.issn.1671-170X.2018.05.B011 |
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| 中文关键词: 乳腺癌 调强放疗 心胸比 肺脏最大距离 心脏最大距离 |
| 英文关键词:breast cancer intensity-modulated radiotherapy cardiothoracic ratio central lung distance maximum heart distance |
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| 中文摘要: |
| 摘 要：［目的］ 探讨患者的心胸比（cardiothoracic ratio，CTR），肺脏最大距离（central lung distance，CLD），心脏最大距离（maximum heart distance，MHD），计划靶区体积(VPTV)对乳腺癌保乳术后两种调强放疗计划结果的各个目标参数值的预测。［方法］ 2016年6月至2017年3月在我院接受全乳调强放疗的48例女性乳腺癌保乳术后患者（31例左侧，17例右侧），患者PTV处方剂量为 50Gy，分割剂量2Gy/次。PTV达到95%的处方剂量为满足临床要求。每个患者设计两个治疗计划，P1为三维适形+逆向调强的混合计划（3DCRT+IMRT），三维适形计划为两野切线野，剂量为80%处方剂量；IMRT为四野的逆向静态调强计划，剂量为20%处方剂量，P2为6野全切线野的逆向静态调强计划，P1和P2计划子野都是24个。调强计划同时使用物理参数和等效生物剂量（EUD）对目标函数进行优化。预测影响因子与适形度指数（CI）、均匀性指数（HI）、危及器官（OAR）的剂量体积关系采用单因素和多元线性回归进行分析。［结果］ （1）MHD是左侧乳腺癌P１计划VHeart30、VHeart10、DmeanHeart的独立预测影响因子。P１计划的预测公式：VHeart30-P1=-1.3+4.5MHD，MHD、CTR是左侧乳腺癌P２计划VHeart30的独立预测影响因子，P2计划的预测公式：VHeart30-P2=-13.7+1.89 MHD+30.53CTR。（2）CLD是左侧乳腺癌P１、P２计划Vlung20、Vlung10、Dmeanlung的预测影响因子和独立预测影响因子，预测公式：Vlung20-P1=10.6+3.9CLD，Vlung20-P2=12.7+3.2CLD。（3）VPTV是左侧乳腺癌P1计划CI的独立预测因子，VPTV、CTR是左侧乳腺癌P２计划CI的独立预测因子，VPTV的B值系数均为0，预测公式：左侧CIP1-左=0.54，CIP2-左＝0.38+0.32CTR；MHD是左侧乳腺癌P1计划HI的独立预测因子，CLD左侧乳腺癌P２计划HI的独立预测因子，预测公式：左侧乳腺癌HIP1-左=1.08+0.006MHD，HIP2-左=1.06+0.015CLD；CTR是右侧乳腺癌P１计划CI的独立预测影响因子，VPTV是右侧乳腺癌P2计划CI的独立预测影响因子，预测公式：右侧CIP1-右=0.23+0.85CTR，CIP2-右＝0.48。［结论］ 预测因子CTR、CLD、MHD更适用于左侧乳腺保乳术后的全切线野的逆向静态调强计划结果的初步预测。预测公式可以快速计算计划的CI值、HI值、肺V20和心脏V30的预测值，有助于物理师或剂量师快速选择治疗计划的设计方案，提高临床治疗计划设计的有效性。 |
| 英文摘要: |
| Abstract：［Objective］ To assess the predictive value of cardiothoracic ratio(CTR)，central lung distance(CLD)，maximum heart distance(MHD) and volume of PTV(VPTV) in predicting target parameters of two intensity modulated radiation therapy(IMRT) plans for breast cancer patients after breast conserving surgery. ［Methods］ Forty eight female patients with breast cancer(31 cases on left and 17 cases on right) receiving whole breast IMRT after conservative surgery between June 2016 and March 2017 were enrolled in the study. The PTV prescriptive dose was 50Gy with 2Gy/F and when PTV reached 95% prescribed dose，it met clinical requirements. Two treatment plans were designed for each patient：P1 and P2. P1 was a three-dimensional conformal + intensity-modulated radiation therapy(3DCRT + IMRT). The three-dimensional optimal plan was two field tangents with 80% of prescribed dose；IMRT plan was quadrant fields reverse static IMRT with 20% of the prescribed dose. P2 was 6 tangent field reverse static IMRT with 95% of the prescribed dose. The sub-fields of P1 and P2 plans were all 24. The target function was optimized by using the physical parameters and the equivalent biological dose(EUD). A linear regression analysis was performed to predict the relationship between the influence factors and the conformal index(CI)，the uniformity index(HI) and the dose volume relationship between the organs at risk. ［Results］ MHD was an independent predictive factor for the left breast cancer P1 plan VHeart30，VHeart10 and DmeanHeart：VHeart30-P1 =-1.3 + 4.5MHD. MHD and CTR were independent predictive factors on left breast cancer P2 plan VHeart30：VHeart30-P2 =-13.7+1.89 MHD+30.53CTR. CLD was the independent predictive factor of left breast cancer P1，P2 plan Vlung20，Vlung10，Dmeanlung：Vlung20-P1 =10.6+3.9CLD，Vlung20-P2 =12.7+3.2CLD. VPTV was an independent predictor of CI of left breast cancer P1 plan，VPTV and CTR are an independent predictor of CI on the left side of the breast cancer P2 plan，the VPTV B value coefficients was 0，the predictive formula：CIP1-left=0.54，CIP2-left=0.38+0.32 CTR. MHD was the independent predictor of the left breast cancer P1 HI，the independent predictor of the left breast cancer P2 of CLD，and the prediction formula：HIP1-left =1.08+0.006 MHD，HIP2-left =1.06+0.015CLD. CTR was independent predictive factor of right breast cancer P1 CI，VPTV was independent predictive factor P2 CI of right breast cancer：CIP1-right=0.23+0.85CTR，CIP2-right=0.48. ［Conclusion］ CTR，CLD and MHD are more suitable for the preliminary prediction of the reverse static intensity adjustment of the left breast cancer. The predictive values of CI，HI，lung V20 and heart V30 can be quickly calculated，which facilitates to effectively design treatment plan and improve the clinical efficacy for breast cancer patients. |
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