本文選題：早期乳腺癌 + 放射治療��； 參考：《輻射研究與輻射工藝學(xué)報》2016年03期

【摘要】：探討調(diào)強放療(Intensity-modulated radiotherapy,IMRT)在早期乳腺癌放療中的劑量學(xué)優(yōu)勢,以期得到有價值的循證醫(yī)學(xué)證據(jù)以指導(dǎo)臨床應(yīng)用。使用計算機檢索Pub Med、EMbase、Sciencedirect、中國知網(wǎng)、維普、萬方數(shù)據(jù)庫,同時輔助其它檢索,收集關(guān)于早期乳腺癌保乳術(shù)后三維適形技術(shù)(Three-dimensional conformal radiotherapy,3D-CRT)與IMRT劑量學(xué)比較的文獻,應(yīng)用Rev Man 5.2.0軟件對滿足條件的15項(263例患者)數(shù)據(jù)進行Meta分析。結(jié)果表明,與3D-CRT相比,IMRT顯著降低了患側(cè)肺V20(p=0.004)、V30(p=0.008)、V40(p=0.000 8)、Dmax(p=0.001)和心臟V30(p=0.002)、V40(p=0.000 01);降低了計劃靶區(qū)Dmax(p0.000 01);對V95(p=0.05)、V105(p0.000 1)、V110(p0.000 01)覆蓋更好;均勻指數(shù)HI及適形指數(shù)CI也較好,p=0.02;但卻增加了患側(cè)肺V5(p=0.000 5)、V10(p=0.05),心臟V5(p0.000 1)、V10(p=0.000 7),健側(cè)肺V5(p=0.002)、Dmen(p=0.000 4)和健側(cè)乳腺V3(p=0.000 6)。計劃靶區(qū)V100、Dmean、Dmin、患側(cè)肺Dmean、心臟V20、Dmax、Dmean、健側(cè)乳腺Dmean,IMRT與3D-CRT相似,差異不顯著。結(jié)果提示,在早期乳腺癌保乳術(shù)后放療中,IMRT對靶區(qū)覆蓋好且劑量分布均勻,并可以減少高劑量照射區(qū)正常組織的劑量,保護正常組織,但卻增加了低劑量照射區(qū)組織的劑量。
[Abstract]:To investigate the dosimetric advantages of IMRT in early breast cancer radiotherapy with IMRT in order to obtain valuable evidence-based medical evidence to guide clinical application. A computer search was used to retrieve Pub Medsite EMbase Science Direction, China knowledge Network, Weip, Wanfang database, and to assist with other searches, to collect the literature on Three-dimensional conformal radiotherapyne 3D-CRT and IMRT dosimetry comparison after breast conserving surgery for early breast cancer. Rev Man 5.2.0 software was used to analyze the data of 15 items and 263 patients. The results showed that compared with 3D-CRT, the Dmax(p0.000 of the affected lung V20 / p0. 004 was significantly lower than that of 3D-CRT, and the coverage was better for V95 / 5 / 0. 05 ~ (0. 05) / V _ (10 ~ (10) / p ~ (0. 01) and the heart (V _ (30) / P ~ (0.002) / V _ (40) / p ~ (0. 001) and the planned target area was lower than that of the control group (P = 0. 005 / 0. 05 / 0. 05 / 0. 05 / 0. 05) / 0. 01 / 0 / 0 / 0). The homogeneous index HI and conformal index CI were also better than P0. 02, but increased the number of V5(p=0.000 5, V5(p0.000 1, V10, Dmenp0. 000 4 and V3(p=0.000 6. 000 4 of the normal lung and the normal side of the lung, respectively, and the V3(p=0.000 of the normal side of the breast was 0. 004 and 0. 004, respectively, and that of the normal lung was 0. 002 and 0. 004 respectively, and that of the normal side was 0. 007 and 0. 00007 respectively, and that of the normal lung was 0. 002, respectively. There were no significant differences in Dmean Dmean, Dmean Dmean, Dmean Dmean of the affected lung, Dmax Dmax Dmean of the heart, Dmean IMRT of the normal breast and 3D-CRT in the target area of the plan, but no significant difference was found between the Dmean of the affected lung and that of the normal breast. The results suggest that IMRT covers the target area well and the dose distribution is uniform in early breast cancer after breast conserving surgery, and it can reduce the dose of normal tissue and protect normal tissue in high dose area, but increase the dose of tissue in low dose area.
【作者單位】： 中國醫(yī)科大學(xué)附屬第四醫(yī)院放療科;
【基金】：遼寧省醫(yī)院改革重點臨床科室診療能力建設(shè)項目(NCCC-B08-2014)資助~~
【分類號】：R737.9;R730.55

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