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目的:研究2种体位乳腺癌根治术后全X线照射胸壁及锁骨上区的肺剂量学差异,为进一步选择减轻肺放射性损伤的治疗体位提供理论依据。方法:回顾分析2006年1月至2014年12月在我院行乳腺癌术后胸壁及锁骨上区全X线切线野及单前野放射治疗的192例患者资料,其中平卧位92例,胸骨水平位100例,采集2组患者靶区等剂量曲线及肺剂量体积直方图,评价靶区覆盖度及肺剂量分布的差异。结果:平卧位组及胸骨水平位组90%处方剂量完全覆盖计划靶区,均达到放射治疗剂量学要求,靶区均匀指数及适形指数并无统计学差异(P>0.05);平卧位组及胸骨水平位组患侧肺V20分别为:(29.9±2.5)%和(32.4±3.2)%(P=0.000),患侧肺V30:(24.8±6.3)%和(26.8±1.9)%(P=0.002);患侧肺Dm:(16.4±3.0)Gy和(18.1±1.8)Gy(P=0.000);全肺V20:(14.6±2.1)%和(17.4±2.5)%(P=0.000),全肺V30:(8.4±1.6)%和(13.9±1.7)%(P=0.000);全肺Dm:(7.4±0.7)Gy和(8.2±0.7)Gy(P=0.000),差异均具有统计学意义。结论:乳腺癌根治术后全X线照射胸壁及锁骨上区,2种体位靶区覆盖度无明显差异;平卧位较胸骨水平位有更优的肺剂量分布。
OBJECTIVE: To study the difference of lung dosimetry in chest wall and supraclavicular region after radiotherapy for 2 kinds of position breast cancer radical mastectomy, so as to provide a theoretical basis for further selecting and reducing the treatment position of lung radiological injury. Methods: The data of 192 patients with chest X-ray and full anterior radiotherapy of chest wall and supraclavicular area in our hospital from January 2006 to December 2014 were analyzed retrospectively. The data of 92 patients with supine position, The level of 100 cases, collecting two groups of patients target dose curve and lung dose volume histogram to assess the target coverage and lung dose distribution differences. Results: 90% of the prescription dose in the supine group and the sternal bone level completely covered the planned targets, all of which met the requirements of radiation dosimetry. There was no significant difference (P> 0.05) between the target index and conformal index (P> 0.05). The V20 of lateral lung in the position and sternal level group were (29.9 ± 2.5)% and (32.4 ± 3.2)% (P = 0.000), and V30 in the ipsilateral lung were (24.8 ± 6.3) and (26.8 ± 1.9) % (P = 0.002); ipsilateral lung Dm: (16.4 ± 3.0) Gy and (18.1 ± 1.8) Gy (P = 0.000); whole lung V20: (14.6 ± 2.1)% and (17.4 ± 2.5)% = 0.000), whole-lung V30: (8.4 ± 1.6)% and (13.9 ± 1.7)% (P = 0.000) Differences were statistically significant. CONCLUSION: There is no significant difference in the coverage of the two kinds of target after chest X-ray irradiation and chest X-ray after radical mastectomy. The supine position has better lung dose distribution than the sternum.