摘要
目的:比较研究Ethos自适应放射治疗系统的Auto Plan(自动计划)与Fall back Plan(导入计划)在乳腺癌保乳术后放射治疗中的剂量学差异,探讨Ethos平台下两种技术在乳腺癌保乳术后放疗中的临床价值。方法:回顾性选择2022年在上海交通大学医学院附属瑞金医院行乳腺癌保乳术后放射治疗的15例乳腺癌患者资料。基于Ethos计划系统为每例患者分别设计调强放射治疗(IMRT)7、9和12野均分(7F_IMRT、9F_IMRT和12F_IMRT)的自动计划,以及12野的导入计划,对比评价左、右乳自动计划与导入计划靶区剂量分布的适形指数(CI)、均匀性指数(HI)及危及器官(OAR)的剂量学差异。结果:导入计划能够改善靶区剂量分布,15例患者靶区剂量平均HI为0.020±0.005,优于7F_IMRT、9F_IMRT和12F_IMRT的3种自动计划的0.065±0.015、0.024±0.004和0.024±0.0045,差异有统计学意义(t=12.687、3.638、4.885,P<0.05)。在8例左乳腺癌患者中,导入计划OAR患侧肺的平均剂量(D_(mean))、接受5、10、20、30Gy剂量的体积百分比(V_(5Gy)、V_(10Gy)、V_(20Gy)、V_(30Gy))均优于3种自动计划,差异有统计学意义(F=24.31、64.59、18.02、7.32、5.74,P<0.05);导入计划的心脏受量平均D_(mean)、V_(5Gy)、V_(10Gy)、V_(30Gy)分别为(244.83±53.93)cGy、(9.64±2.94)%、(4.28±2.0)%、(0.51±0.5)%,均优于3种自动计划,差异有统计学意义(F=10.17、12.05、4.59、3.95,P<0.05);导入计划健侧肺D_(mean)和V_(5Gy)及健侧乳腺的D_(mean)均优于3种自动计划,差异有统计学意义(F=27.99、6.26、35.89,P<0.05)。在7例右乳腺癌患者中,导入计划OAR患侧肺D_(mean)、V_(5Gy)、V_(10Gy)、V_(20Gy)、V_(30Gy)均优于3种自动计划,差异有统计学意义(F=3.43、3.85、2.32、2.36、3.59,P<0.05)。导入计划心脏Dmax、D_(mean)、V_(5Gy)均优于3种自动计划,差异有统计学意义(F=10、10.22、3.96,P<0.05)。导入计划的健侧肺的D_(mean)及V_(5Gy)及健侧乳腺D_(mean)的均优于3种自动计划,差异有统计学意义(F=20.87、4.17、59.83,P<0.05)。结论:导入计划与7F_IMRT、9F_IMRT及12F_IMRT的Ethos系统自动计划相比,靶区均匀性更好,患侧肺以及心脏的剂量更低,且其他OAR的剂量均在临床限制要求之内。导入计划在乳腺癌保乳术后放射治疗中具有更高的临床应用价值。
Objective:To compare and research dosimetric differences between auto plan and fall back plan in Ethos adaptive radiotherapy system in radiotherapy after breast conserving surgery for breast cancer,and explore the clinical value of two techniques under the Ethos platform in the radiotherapy after breast conserving surgery.Methods:The data of a total of 15 patients with breast cancer,who received radiotherapy after breast conserving surgery for breast cancer at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine in 2022,were selected.Based on the Ethos planning system,the auto plans of the average score of 7 fields(7F_IMRT),9 field(9F_IMRT)and 12 field(12F_IMRT),as well as a fall back plan of 12 fields,were designed respectively for each patient.The dosimetric differences of conformity index(CI)and homogeneity index(HI)of dose distribution of target region,and the dose of organs at risk(OAR)were compared and evaluated.Results:The fall back plan can improve dose distribution of target region,and the average HI value of the dose of target region of 15 patients was 0.020±0.005,which was superior to those[7F_IMRT(0.065±0.015),9F_IMRT(0.024±0.004)and 12F_IMRT(0.024±0.0045)]of 3 kinds of auto plans,and the differences of them between two kinds of plans were significant(F=12.687,3.638,4.885,P<0.05).In 8 patients with breast cancer at left side,the mean dose(D_(mean)),volume percentages in receiving 5,10,20,30 Gy doses(V_(5Gy),V_(10Gy),V_(20Gy),V30Gy)in the affected side of lung in fall back plan were better than those in auto plan,and the differences of them between two kinds of plans were significant(F=24.31,64.59,18.02,7.32,5.74,P<0.05).The average D_(mean) of receiving dose of heart,V_(5Gy),V_(10Gy) and V30Gy of fall back plan were respectively(244.83±53.93)cGy,(9.64±2.94)%,(4.28±2.0)%and(0.51±0.5)%,which were better than those of three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=10.17,12.05,4.59,3.95,P<0.05).The D_(mean) and V_(5Gy) of the health side of lung,and D_(mean) of health side of breast in fall back plan were better than those in three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=27.99,6.26,35.89,P<0.05).In 7 patients with breast cancer at right side,the D_(mean),V_(5Gy),V_(10Gy),V_(20Gy) and V30Gy of affected side of lung in fall back plan were better than those of three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=3.43,3.85,2.32,2.36,3.59,P<0.05).The Dmax,D_(mean) and V_(5Gy) of heart in fall back plan were all better than those of three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=10,10.22,3.96,P<0.05).The D_(mean) and V_(5Gy) of health side of lung,and the D_(mean) of health side of breast in fall back plan were better than those in three kinds of auto plans,and the differences of them between two plans were significant(F=20.87,4.17,59.83,P<0.05).Conclusion:Compared with auto plan of Ethos system of 7F_IMRT,9F_IMRT and 12F_IMRTB,the homogeneity of target region of the Fall Back plan is better,and the doses of lung and heart of affected side of that are lower,and the doses of other OAR all were within the requirement of clinical limitation.Fall back plan has higher clinical application value in radiotherapy after breast conserving surgery for breast cancer.
作者
李超
曹璐
祁伟祥
段隆焱
Li Chao;Cao Lu;Qi Weixiang;Duan Longyan(Department of Radiotherapy,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Shanghai Key Laboratory for Translational Research in Proton Therapy,Shanghai 200025,China)
出处
《中国医学装备》
2025年第3期10-16,共7页
China Medical Equipment
基金
上海市卫生健康委员会卫生行业临床研究专项(20224Y0025)
2023年度上海市卫生健康委员会临床研究专项面上项目(202340226)。
