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目的探讨早期乳腺癌保乳术后自主呼吸控制(ABC)辅助部分乳腺三维适形放疗的方法、剂量学特点和近期疗效。方法ABC辅助CT模拟定位,获得适度深吸气呼吸控制(mDIBH)状态下CT图像。银夹标记的范围勾画为肉眼靶区(GTV),GTV外扩15 mm作为计划靶区(PTV),采用6 MV X线4个野非共面照射,处方剂量为34 Gy分10次5d完成。计算GTV、PTV、PTV占患侧全乳的比例,100%、95%、90%等剂量线分别包括PTV百分比,34.0、27.2、20.4、13.6、6.8 Gy照射剂量分别包括的患侧乳腺体积百分比、患侧肺和健侧肺及心脏Dmean、D5、V20。评价急性放射性皮肤反应和乳房美容效果,观察局部肿瘤控制和生存率。结果PTV与患侧乳腺体积比值的平均值为14.88%。90%等剂量线包括的PTV平均值为92.54%。100%处方剂量包括患侧乳腺体积的平均值为17.23%,20%处方剂量包括患侧乳腺体积的平均值为46.11%。患侧肺Dmean、D5和V20平均值分别为1.97、9.25 Gy和1.58%。心脏Dmean、D5和V20分别为0.65、2.82 Gy和0.85%。放疗后1个月急性皮肤反应为0级12例、1级5例。放疗后6个月评估美容效果满意率达100%。放疗后1年局部肿瘤控制率和1年无瘤生存率均为100%。结论早期乳腺癌保乳术后ABC辅助三维适形放疗部分乳腺是可行的,但病例选择标准、技术规范、剂量分割及对远期美容效果、局部肿瘤控制和远期生存的影响有待进一步探讨和观察。
Objective To investigate the methods, dosimetric characteristics and short-term curative effect of three-dimensional conformal radiotherapy assisted by spontaneous breathing control (ABC) in breast cancer after breast-conserving surgery. Method ABC assisted CT simulation positioning, access to moderate deep breathing breath control (mDIBH) CT images. The range of silver clip markings was outlined as GTV, with 15 mm GTV as the planned target volume (PTV) and 4 wild non-coplanar 6 MV radiographs at a prescribed dose of 34 Gy at 10 doses for 5 days . The percentages of GTV, PTV and PTV in total ipsilateral milk were calculated. The 100%, 95% and 90% isodose lines included PTV percentage, 34.0,27.2,20.4,13.6,6.8 Gy dose, respectively, , Ipsilateral and contralateral lung and heart Dmean, D5, V20. Evaluation of acute radiation skin reaction and breast cosmetic effect, observe the local tumor control and survival rate. Results The average volume ratio of PTV to ipsilateral breast was 14.88%. The 90% isodose line included an average PTV of 92.54%. The 100% prescription dose included an average of 17.23% for the ipsilateral breast volume and 46.11% for the 20% prescribed dose including the ipsilateral breast volume. The ipsilateral lung Dmean, D5 and V20 mean were 1.97,9.25 Gy and 1.58% respectively. Heart Dmean, D5 and V20 were 0.65, 2.82 Gy and 0.85%, respectively. One month after radiotherapy, the acute skin reaction was grade 0 in 12 cases and grade 1 in 5 cases. Six months after radiotherapy cosmetic effects satisfaction rate of 100%. One year after radiotherapy local tumor control rate and 1-year disease-free survival rate were 100%. Conclusion ABC-assisted three-dimensional conformal radiotherapy of breast may be feasible in early breast cancer after breast-conserving surgery. However, the selection criteria, technical criteria, dose division and its effect on long-term cosmetic effect, local tumor control and long-term survival need to be further discussed. Observed.