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目的探讨早期乳腺癌患者保乳术后仰卧位与俯卧位调强放疗的剂量,旨在改善乳腺剂量均匀性。方法选取2013年6月至2015年6月江苏省沭阳县人民医院30例进行保乳术后放疗的早期左侧乳腺癌患者,均分别进行仰卧位与俯卧位的CT扫描,每例患者采用仰卧位与俯卧位进行切线2野照射,比较两种体位靶区剂量分布,右乳、心脏、左肺的受照体积及剂量,机器跳数。结果仰卧位与俯卧位所勾画的临床靶区体积之间的差异无统计学意义(P>0.05)。仰卧位大体肿瘤靶区(CTV)V_(105%)和D_(mean)显示<俯卧位,D_(max)显示>俯卧位,差异有统计学意义(P<0.05)。仰卧位计划治疗靶区(PTV)V_(95%)、V_(105%)、D_(mean)、D_(min)和D_(max)显著优于俯卧位,差异有统计学意义(P<0.05)。仰卧位照射野最大切肺深度为(2.9±0.8)cm,显著高于俯卧位的(1.3±0.4)cm,差异有统计学意义(P<0.05)。仰卧位的右侧乳腺V5显著低于俯卧位,心脏和左肺的照射剂量显著高于俯卧位,差异有统计学意义(P<0.05)。俯卧位的机器跳数为(582.4±117.9),仰卧位的机器跳数为(547.6±95.2),两种体位的机器跳数差异无统计学意义(P>0.05)。结论乳腺较大和乳腺下垂患者,俯卧位比仰卧位靶区剂量更为均匀,右乳、心脏和左肺的照射体积与剂量显著降低。
Objective To investigate the dosage of intensity-modulated radiotherapy in supine position and prone position after breast-conserving surgery in early-stage breast cancer patients in order to improve the uniformity of breast dose. Methods From June 2013 to June 2015, 30 patients with early stage left breast cancer after breast-conserving radiotherapy were selected from 30 patients in Shuyang People’s Hospital of Jiangsu Province. All patients underwent CT scan in supine position and prone position. Each patient was supine Bit and prone position tangent 2 field irradiation, comparing the dose distribution of the two body position target, right breast, heart, left lung volume and dose of exposure, the number of machine hops. Results There was no significant difference in clinical target volume between supine position and prone position (P> 0.05). The V_ (105%) and D_metrics of the general tumor target area (CTV) in the supine position showed that the prone position and the max of the maxillary position were displayed in the prone position. The difference was statistically significant (P <0.05). The V_ (95%), V_ (105%), D_ (mean), D_ (min) and D_max of PTV in supine position were significantly better than those in prone position (P <0.05 ). The maximal depth of cut lung in supine position was (2.9 ± 0.8) cm, which was significantly higher than that in prone position (1.3 ± 0.4) cm, the difference was statistically significant (P <0.05). On the right side of the supine position, the V5 of the breast was significantly lower than that of the prone position. The dose of heart and left lung was significantly higher than that of the prone position (P <0.05). The number of hops in the prone position was (582.4 ± 117.9) and that in the supine position was (547.6 ± 95.2). There was no significant difference in hops between the two positions (P> 0.05). Conclusion In the patients with large breasts and breast ptosis, the dose in the prone position is more uniform than that in the supine position, and the volume and dose of irradiation of the right breast, heart and left lung are significantly reduced.