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目的评价乳腺癌放疗时,适形、调强技术对保护正常组织和改善靶区剂量均匀度的作用。方法比较五种乳腺癌照射技术,包括常规切线照射技术、三维适形(3DCRT)切线照射技术、野中野照射技术、调强切线照射技术和调强五野照射技术。随机选择5位乳腺癌患者,为每位患者设计上述五种照射技术的治疗计划。处方剂量为46Gy/2Gy/23f。所有计划都使95%靶区体积达到处方剂量要求。分别比较他们的剂量分布、剂量体积直方图(DVH)、靶区剂量均匀度以及正常组织如肺、心脏所受剂量。结果五种技术靶区剂量均匀度的优劣:3D和调强技术比常规技术有改善趋势。但所有计划的靶区剂量分布方差分析无显著性差异(P=0.951)。3D技术和野中野技术各项指标值都基本相同。5野调强靶区剂量均匀度最佳。五种技术保护正常组织的效果:3D技术在正常组织的保护方面都优于常规技术。调强技术使患侧肺、心脏高剂量区体积降低,低剂量区增加。但使对侧肺和对侧乳腺的受照剂量略有增加。5野调强使正常组织受低剂量照射的范围显著增加。结论对于早期乳腺癌保乳术后放疗,在常规技术已达到较好疗效情况下,仍需要为提高患者生存质量、减少晚期并发症而努力。3DCRT技术在改善靶区剂量均匀度的同时,肺和心脏受照体积和受照剂量均低于常规技术;其计划时间和治疗时间与常规技术相近,因而可认为3DCRT是目前取代常规切线照射技术的较好选择。
Objective To evaluate the effect of conformal and intensity-modulated techniques on the protection of normal tissues and improvement of dose uniformity during breast cancer radiotherapy. Methods Five breast cancer irradiation techniques were compared, including conventional tangential irradiation technique, 3DCRT tangential irradiation technique, Yezhongye irradiation technique, intensity-modulated tangential irradiation technique and Tiangongwuye radiation technique. Five breast cancer patients were randomly selected to design a treatment plan for each of the five irradiation techniques for each patient. Prescription dose of 46Gy / 2Gy / 23f. All programs achieve 95% of target volume to the prescribed dose. Their dose distribution, dose-volume histogram (DVH), target dose uniformity and normal tissue such as lung and heart dose were compared. Results Advantages and Disadvantages of Dosage Uniformity in Five Technical Targets: 3D and IOM techniques tend to improve over conventional techniques. However, there was no significant difference (all P = 0.951) among all planned target area dose distribution ANOVA. 3D technology and wild field technology indicators are basically the same value. 5 wild tonight target area dose uniformity best. The effect of five techniques on normal tissue protection: 3D techniques outperform conventional techniques in the protection of normal tissues. IMRT makes the ipsilateral lung, heart volume lower high dose area, low dose area increased. However, the contralateral lung and contralateral breast slightly increased dose. 5 wild tone to strengthen the scope of normal tissue exposure to low doses of radiation increased significantly. Conclusion In the early stage of breast cancer after breast-conserving surgery radiotherapy, in the conventional technology has reached a better curative effect, still need to improve patient quality of life, reduce late complications and efforts. 3DCRT technology to improve the uniformity of the target dose at the same time, lung and heart volume and dose under exposure dose is lower than the conventional technology; the planned time and treatment time similar to conventional technology, which can be considered 3DCRT is the current alternative to conventional tangential irradiation Better choice.