摘要
目的基于左侧乳腺癌保乳术后患者的CT定位解剖图像,提出一个预测放射治疗前心脏平均剂量(MHD)的方法。方法回顾性分析2018年3月至2023年12月湘雅常德医院收治的120例行左侧乳腺癌保乳术术后放疗患者的临床资料,其中60例行自由呼吸(FB)放疗,60例行深吸气屏气技术(DIBH)放疗。FB和DIBH的病人根据3∶2的比例随机分成训练组(n=72)和测试组(n=48)。根据乳腺癌切线野辐射场的特点,建立一个预测MHD的心脏切割占比(PCH)方法,通过CT定位解剖图像统计心脏切割体积和心脏体积,并计算PCH值。采用Graphpad软件进行回归分析,探讨PCH值与MHD的关系。通过训练组受试者操作特性(ROC)曲线评价MHD的预测能力,提出使用DIBH技术能够获益的PCH的预测阈值。基于测试组的数据验证PCH-MHD关系及PCH阈值的准确性。结果PCH值与MHD存在显著性线性相关(相关系数r=0.918),PCH模型下训练组、测试组的ROC曲线下面积(AUC)分别为0.9799和0.9878,MHD为3.3 Gy的PCH模型的阈值(cut-off value)为0.0193,该阈值具有很高的准确性。结论PCH值与MHD呈显著性线性相关,基于左侧乳腺癌保乳术后CT定位解剖图像预测左侧乳腺癌患者MHD的方法可以在放疗前预测病人的MHD,可为MHD较高(≥3.3 Gy)需要采用DIBH获益的患者提供一个准确的筛选。
Objective Based on the CT localization anatomical images of patients with left-side breast cancer after breast-conserving surgery,to propose a method for predicting the mean heart dose(MHD)before radiation therapy.Methods The clinical data of 120 patients with left-side breast cancer who underwent radiotherapy after breast-conserving surgery in Xiangya Changde Hospital from March 2018 to December 2023 were retrospectively analyzed.Among 120 patients,60 cases underwent free breathing(FB)radiotherapy,and 60 cases underwent deep inspiratory breath-hold technique(DIBH)radiotherapy.The patients with FB and DIBH were randomly divided into the training group and the test group according to the ratio of3:2.According to the characteristics of the tangential radiation field of breast cancer,a proportion of cutting heart(PCH)method for predicting the MHD was established.The volume of cutting heart and volume of heart were measured through CT localization anatomical images,and the PCH value was calculated.Regression analysis was performed using Graphpad software to explore the relationship between PCH value and MHD.The predictive ability of MHD was evaluated through the receiver operating characteristics(ROC)curve of the training group,and the predictive threshold for indicating the benefit of using the DIBH technique was proposed.The accuracy of the PCH-MHD relationship and the PCH threshold were validated based on data from the test group.Results There was significant linear correlation between PCH value and MHD(correlation coefficient r=0.918).The area under the curve(A UC)of ROC in the training group and the test group under the PCH model were 0.9799 and 0.9878,respectively.Additionally,the threshold(cut-off value)for the PCH model with MHD of 3.3 Gy was 0.0193,which demonstrated high accuracy.Conclusions There is significant correlation between PCH value and MHD.This method for predicting MHD of left-side breast cancer patients based on the CT localization anatomical images after left-side breast-conserving surgery can predict MHD of patients before radiation therapy,and provide an accurate screening for patients with high MHD(≥3.3Gy)who wouldbenefit from DIBH.
作者
张校铭
付鑫
李军烽
钟美佐
陈俊
郑乐
刘礼东
彭美霞
周韦伦
秦勤
ZHANG Xiaoming;FU Xin;LI Junfeng;ZHONG Meizuo;CHEN Jun;ZHENG Le;LIU Lidong;PENG Meixia;ZHOU Weilun;QIN Qin(Department of Oncology,Xiangya Changde Hospital,Changde 415000,China;Department of Oncology and Radiotherapy,Shenzhen People's Hospital,Shenzhen 518020,China)
出处
《临床医学工程》
2025年第5期459-464,共6页
Clinical Medicine & Engineering
基金
2024年度常德市医卫类专项课题(序号:20)。
关键词
左乳腺癌
CT图像
心脏切割占比
心脏平均剂量
深吸气屏气技术
Left-side breast cancer
CT image
Proportion of heart cutting
Mean heart dose
Deep inspiratory breath-hold technique
