Meta分析保乳术后三维适形与调强技术剂量学比较

发布时间：2018-05-14 13:18

本文选题：早期乳腺癌 + 放射治疗　；参考：《辐射研究与辐射工艺学报》2016年03期

【摘要】：探讨调强放疗(Intensity-modulated radiotherapy,IMRT)在早期乳腺癌放疗中的剂量学优势,以期得到有价值的循证医学证据以指导临床应用。使用计算机检索Pub Med、EMbase、Sciencedirect、中国知网、维普、万方数据库,同时辅助其它检索,收集关于早期乳腺癌保乳术后三维适形技术(Three-dimensional conformal radiotherapy,3D-CRT)与IMRT剂量学比较的文献,应用Rev Man 5.2.0软件对满足条件的15项(263例患者)数据进行Meta分析。结果表明,与3D-CRT相比,IMRT显著降低了患侧肺V20(p=0.004)、V30(p=0.008)、V40(p=0.000 8)、Dmax(p=0.001)和心脏V30(p=0.002)、V40(p=0.000 01);降低了计划靶区Dmax(p0.000 01);对V95(p=0.05)、V105(p0.000 1)、V110(p0.000 01)覆盖更好;均匀指数HI及适形指数CI也较好,p=0.02;但却增加了患侧肺V5(p=0.000 5)、V10(p=0.05),心脏V5(p0.000 1)、V10(p=0.000 7),健侧肺V5(p=0.002)、Dmen(p=0.000 4)和健侧乳腺V3(p=0.000 6)。计划靶区V100、Dmean、Dmin、患侧肺Dmean、心脏V20、Dmax、Dmean、健侧乳腺Dmean,IMRT与3D-CRT相似,差异不显著。结果提示,在早期乳腺癌保乳术后放疗中,IMRT对靶区覆盖好且剂量分布均匀,并可以减少高剂量照射区正常组织的剂量,保护正常组织,但却增加了低剂量照射区组织的剂量。
[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.
【作者单位】：中国医科大学附属第四医院放疗科;
【基金】：辽宁省医院改革重点临床科室诊疗能力建设项目(NCCC-B08-2014)资助~~
【分类号】：R737.9;R730.55

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