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目的:通过研究使用乳腺托架的乳腺癌患者锁骨上区外照射时正常肺组织的受照情况,寻找能明显减少肺受照体积和剂量的新方法。方法:选取乳腺癌根治术后和保乳术后需照射胸壁和锁骨上区的10例患者,使用CMS XiO治疗计划系统,三维适形放射治疗计划设计,新方法为转床90°,锁骨上野机架角向患者脚侧倾斜,保证射野中心线垂直于乳腺托架底板,统计同侧肺受照绝对体积,以及V5和V20情况,并观察125例使用新方法照射锁骨上区与胸壁野衔接处患者局部皮肤的情况。结果:乳腺癌患者锁骨上区照射时,使用常规方法14.9%同侧肺被照射,而新方法仅5.3%同侧肺被照射。比较常规方法,新方法的V5减少53.6%,V20减少59%。125例使用新方法照射锁骨上区与胸壁野衔接处的患者,局部皮肤未出现严重急性皮肤反应。结论:新方法在不改变患者的治疗体位情况下,只通过旋转床,给一个小角度倾斜的锁骨上野,就能保证锁骨上区靶体积的照射剂量,但却能大大减少同侧正常肺照射体积,可能减少放射性肺炎的发生,值得推广应用。
OBJECTIVE: To find a new method to significantly reduce the volume and dose of lung exposure by studying the exposure of normal lung tissue to supraclavicular irradiation in breast cancer patients using breast brackets. Methods: Ten cases of breast cancer who underwent radical mastectomy and breast-conserving surgery were selected to receive the chest X-ray and the supraclavicular region. The CMS XiO treatment planning system and three-dimensional conformal radiotherapy were designed. The new method was 90 ° rotation of the bed, supraclavicular The angle of the chassis was tilted to the patient’s foot to ensure that the centerline of the radio field was perpendicular to the floor of the breast bracket. The absolute volume of irradiated ipsilateral lung as well as V5 and V20 were measured. 125 cases were observed using the new method to illuminate the supraclavicular and chest wall Patient at the junction of the local skin conditions. Results: In the supraclavicular region of breast cancer patients, 14.9% of the ipsilateral lungs were irradiated using the conventional method, while only 5.3% of the ipsilateral lungs were irradiated with the new method. Compared with the conventional method, the V5 decreased by 53.6% and the V20 decreased by 59%. 125 cases of patients using the new method of irradiation at the junction of the supraclavicular region and the chest wall did not show any severe acute skin reaction on the topical skin. Conclusion: The new method can ensure the dose of target area on the supraclavicular area, but can greatly reduce the radiation intensity of the ipsilateral normal lung without changing the position of the patient. Volume, may reduce the incidence of radiation pneumonitis, it is worth promoting the application.