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目的:评估适度深吸气(mDIBH)呼吸控制状态下乳腺癌保留乳房术后全乳正向调强外照射的剂量学优势。方法:入组的18例乳腺癌保留乳房术患者,在自主呼吸控制技术配合下进行CT定位扫描,获得1幅自由呼吸(FB)及1幅mDIBH的图像。采用Pinnacle7.4f治疗计划系统,分别在FB的图像上和mDIBH的图像制定全乳腺正向调强外照射计划,比较2个计划的正常组织和靶区的受照射情况。结果:FB状态下的计划靶区剂量均匀性及适形性与mDIBH状态下的计划相似(1.08±0.01 vs 1.09±0.01,P=0.776;0.59±0.08 vs 0.60±0.04,P=0.821);FB状态下患侧肺V20和V30分别为(13.07±3.93)%和(11.68±3.90)%,均较mDIBH状态下的(9.75±3.58)%和(8.12±3.23)%高,P=0.000。9例左侧乳腺癌患者在FB状态下心脏的V20和V30分别为(5.42±3.21)%和(3.70±2.84)%,均较mDIBH状态下的(2.73±1.95)%和(1.48±0.22)%高,P<0.05。结论:与FB状态相比,mDIBH呼吸控制状态下可减少乳腺癌保留乳房术后全乳腺正向调强外照射的肺和心脏受照射剂量。
OBJECTIVE: To assess the dose-response advantages of positive breast-enlargement external radiation after breast-conserving breast surgery under moderate deep inspiration (mDIBH). Methods: Totally 18 breast cancer patients undergoing breast surgery were enrolled in this study. CT scanning was performed under the control of spontaneous breathing control. One free breathing (FB) and one mDIBH image were obtained. The Pinnacle 7.4f treatment planning system was used to make the whole breast positive intensity external irradiation plan on the FB images and the mDIBH images, respectively. The exposure of the two planned normal tissues and target areas was compared. Results: The dose uniformity and conformality of planned target area in FB state were similar to those in mDIBH state (1.08 ± 0.01 vs 1.09 ± 0.01, P = 0.776; 0.59 ± 0.08 vs 0.60 ± 0.04, P = 0.821) (13.07 ± 3.93)% and (11.68 ± 3.90)%, respectively, which were significantly higher than those in mDIBH (9.75 ± 3.58)% and (8.12 ± 3.23)% respectively, P = 0.000.9 In the left breast cancer patients, the V20 and V30 in the FB state were (5.42 ± 3.21)% and (3.70 ± 2.84)%, respectively, which were significantly higher than those in the mDIBH state (2.73 ± 1.95% and 1.48 ± 0.22% High, P <0.05. CONCLUSIONS: Compared with FB state, mDIBH respiratory control can reduce the radiation dose of lung and heart in the whole mammary gland with positive intensity modulated external mammary surgery.