| 郑博雅,任 毅,朱志坚,等.基于解剖特征的左侧乳腺癌放疗心脏剂量学分析：3D-CRT、IMRT与VMAT技术比较[J].肿瘤学杂志,2026,32(2):134-140. |
| 基于解剖特征的左侧乳腺癌放疗心脏剂量学分析：3D-CRT、IMRT与VMAT技术比较 |
| Dosimetric Analysis of Cardiac Exposure in Left-Sided Breast Cancer Radiotherapy Based on Anatomical Features： a Comparison of 3D-CRT， IMRT， and VMAT Techniques |
| 投稿时间：2025-08-08 |
| DOI：10.11735/j.issn.1671-170X.2026.02.B007 |
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| 中文关键词: 乳腺肿瘤 心脏保护 适形放疗 调强适形放疗 容积调强放疗 左前降支冠状动脉 剂量学分析 解剖因素 个体化治疗 |
| 英文关键词:breast neoplasms cardioprotection conformal radiotherapy intensity-modulated radiotherapy volumetric modulated arc therapy left anterior descending coronary artery dosimetric analysis anatomical factors individualized treatment |
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| 中文摘要: |
| 摘 要：［目的］ 比较三维适形放疗（three dimensional-conformal radiotherapy，3D-CRT）、调强适形放疗（intensity-modulated radiotherapy，IMRT）和容积调强放疗（volumetric modulated arc therapy，VMAT）3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（left anterior descending coronary artery，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。基于每例患者的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）3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，并分析其与计划靶区（planning target volume，PTV）与心脏距离、心脏体积等解剖因素的相关性。［结果］ VMAT在心脏保护方面显著优于其他两组（P<0.001）：其中 VMAT心脏Dmean中位数为3.49 Gy，低于IMRT（3.50 Gy）和3D-CRT（4.56 Gy）；心脏V20中位数为1.13%，较IMRT（1.62%）和3D-CRT（4.05%）更低；且LAD V40中位数为0，显著低于3D-CRT的39.49%和IMRT的5.34%（P<0.001）。VMAT组所有病例的LAD V40均满足临床指南要求（达标率100.0%），而3D-CRT和IMRT组达标率仅分别为5.0%和75.0%。相关性分析显示，各计划PTV心脏距离与LAD V40均呈负相关（P<0.05），当距离<6 mm时，3D-CRT的LAD V40超标率达85.0%以上。［结论］ VMAT技术可显著降低心脏及LAD的受照剂量，尤其PTV与心脏距离较近时优势更为明显。PTV与心脏距离是影响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: |
| Abstract：［Objective］ To compare the cardiac dosimetric differences among three dimensional-conformal radiotherapy (3D-CRT)， intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for post-operative radiotherapy of left-sided breast cancer， with a focus on the dosimetric impact on the left anterior descending coronary artery (LAD). ［Methods］ This study enrolled 20 patients who underwent breast-conserving surgery for left-sided breast cancer. For each patient， three distinct radiotherapy plans were designed based on CT simulation images： 3D-CRT (using a tangential field technique)， IMRT (a 7-field equispaced plan) and VMAT (dual-arc rotation irradiation). Key dosimetric parameters， including the mean heart dose (Dmean)， heart V20 (volume receiving ≥20 Gy)， and LAD V40 (volume of LAD receiving ≥40 Gy)， were evaluated. Correlations between these dose parameters and anatomical factors， such as the heart-planning target volume (PTV) distance and heart volume， were analyzed. ［Results］ VMAT demonstrated significantly superior cardiac protection compared to the other two techniques (P<0.001). The median mean heart dose was 3.49 Gy for VMAT， lower than that for IMRT (3.50 Gy) and 3D-CRT (4.56 Gy). The median heart V20 was 1.13% for VMAT， also lower than that for IMRT (1.62%) and 3D-CRT (4.05%). Notably， the median LAD V40 was 0 for VMAT， significantly lower than the 39.49% for 3D-CRT and 5.34% for IMRT (P<0.001). All cases (100.0%) in the VMAT group met the clinical guideline constraint for LAD V40， whereas the compliance rates were only 5.0% and 75.0% in the 3D-CRT and IMRT groups， respectively. Correlation analysis revealed a significant negative correlation between the heart-PTV distance and LAD V40 across all plans (P<0.05). When this distance was less than 6 mm， the rate of LAD V40 exceeding the guideline constraint was over 85.0% in the 3D-CRT group. ［Conclusion］ VMAT significantly reduces radiation dose to the heart and the LAD. Its advantage is particularly pronounced when the planning target volume is in close proximity to the heart. The heart-PTV distance is an important anatomical factor influencing LAD dose and may serve as a valuable reference for the individualized selection of radiotherapy techniques. |
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