摘要
目的:研究旨在比较调强放射治疗(IMRT)与三维适形放射治疗(3D-CRT)在乳腺癌保乳术后治疗中的剂量优化效果及毒性反应,为乳腺癌患者提供更加精准、安全的治疗方案。方法:选取2021年1月—2023年8月于建湖县人民医院接受乳腺癌保乳手术的70例患者作为研究对象。按照入院顺序分为研究组(接受IMRT,35例)和对照组(接受3D-CRT,35例)。治疗总剂量为60 Gy,分为全乳腺照射50 Gy和瘤床补量10 Gy。对比两组患者靶区剂量、危及器官剂量及急性、晚期毒性反应。结果:研究组特定剂量水平所覆盖的靶区体积百分比(V)95%高于对照组,而V107%、V110%、均匀性指数(HI)低于对照组,差异均有统计学意义(t=9.484、15.882、16.353、31.317,P<0.05);研究组在患侧肺和双肺的V5%和V20%剂量明显低于对照组,差异均有统计学意义(t=9.841、11.189、5.685、9.871,P<0.001),而心脏与健侧乳腺的V5%和V20%剂量比较,差异均无统计学意义(t=0.269、0.080,P>0.05);两组患者乳腺纤维化I级毒性反应比较,差异有统计学意义(χ^(2)=0.031,P<0.05);两组患者在皮肤反应、乳腺组织炎症、局部水肿、肺部毒性、心脏毒性比较,差异均无统计学意义(χ^(2)=0.921、0.516、0.324、0.729、1.061,P>0.05)。结论:IMRT相比3D-CRT能够有效提高靶区剂量的覆盖度,降低危及器官的辐射剂量,并减少乳腺纤维化等晚期毒性反应,具有较好的治疗效果和安全性。
Objective:To compare the effects of intensity-modulated radiation therapy(IMRT)and three-dimensional conformal radiation therapy(3D-CRT)on dose optimization and toxicity in post-lumpectomy breast cancer treatment,so as to provide a more precise and safer therapeutic option for breast cancer patients.Methods:70 patients who underwent breast-conserving surgery for breast cancer in Jianhu County People’s Hospital from January 2021 to August 2023 were enrolled.Patients were divided sequentially into study group(35 cases,receiving IMRT)and control group(35 cases,receiving 3D-CRT).The total radiation dose was 60 Gy,including 50 Gy for whole-breast irradiation and 10 Gy tumor bed boost.Target volume dose,organ-at-risk(OAR)doses,and both acute and late toxicities of two groups were compared.Results:The V95%of the study group was significantly higher than that of the control group,while V107%,V110%and dose homogeneity index(HI)were lower in the study group,with statistically significant differences(t=9.484,15.882,16.353,31.317;P<0.05).The V5%and V20%doses of the ipsilateral lung and both lungs were lower in the study group compared to the control group,with statistically significant differences(t=9.841,11.189,5.685,9.871;P<0.05).However,when comparing the V5%and V20%doses of the heart and the healthy breast,there was no statistically significant difference(t=0.269,0.080;P>0.05).There was statistically significant difference in grade I toxic reactions of breast fibrosis between the two groups(χ^(2)=0.031,P<0.05),while there were no statistically significant differences in skin reactions,breast tissue inflammation,local edema,pulmonary toxicity,and cardiac toxicity(χ^(2)=0.921,0.516,0.324,0.729,1.061;P>0.05).Conclusion:Compared to 3D-CRT,IMRT can significantly improve target volume dose coverage,reduce radiation doses to organs at risk,and decrease late toxicities such as breast fibrosis,demonstrating superior therapeutic efficacy and safety.
作者
黄茜
夏春军
金翔月
Huang Qian;Xia Chunjun;Jin Xiangyue(Department of Radiotherapy,Jianhu Clinical Medical College,Yangzhou University,Yancheng,Jiangsu,224700,China)
出处
《黑龙江医学》
2025年第15期1821-1824,共4页
Heilongjiang Medical Journal
关键词
调强放射治疗
三维适形放射治疗
乳腺癌
保乳术
剂量优化
毒性评估
Intensity-modulated radiation therapy
Three-dimensional conformal radiation therapy
Breast cancer
Breast-conserving surgery
Dose optimization
Toxicity evaluation
