乳腺癌四至九个脑转移瘤患者全脑放疗与射波刀立体定向放疗的剂量学对比研究

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目的:探讨乳腺癌4~9个脑转移瘤患者全脑放疗(WBRT)和射波刀立体定向放疗(SRT)的剂量学特征。方法:回顾性分析解放军总医院第五医学中心2015年3月至11月收治的10例乳腺癌4~9个脑转移瘤患者的临床及影像学资料。将CT及磁共振成像(MRI)图像导入计划系统进行融合,勾画靶区后进行计划设计。WBRT行两野对穿,处方剂量为30 Gy/10次;SRT采用射波刀治疗,处方剂量为16~18 Gy/1次。计算肿瘤靶区体积和剂量以及视神经、视交叉、脑干、海马等危及器官受量,通过生物等效剂量(BED)换算后对WBRT和SRT各放疗剂量指标进行比较。结果:SRT组病灶最大剂量(BEDn 4)高于WBRT组[(191.0±41.3)Gy比(52.5±0.0)Gy,n t=10.596,n P<0.01]。WBRT靶区内脑组织及肿瘤接受同等均匀剂量,均为120.0 Gy。SRT组部分危及器官的中位最大点剂量(BEDn 1)[左视神经为3.9 Gy(0.1~11.2 Gy),右视神经为3.9 Gy(0.2~8.9 Gy),视交叉为5.1 Gy(3.8~19.4 Gy)]低于WBRT组,差异均有统计学意义(均n P<0.05)。SRT组患者脑干1/3体积受照剂量(Vn 1/3)的中位值为4.5 Gy(1.9~5.7 Gy),正常脑组织Vn 2/3的中位剂量为3.1 Gy(1.3~4.3 Gy),左视神经0.2 cmn 3的中位剂量为2.7 Gy(0.0~8.8 Gy),右视神经0.2 cmn 3的中位剂量为3.0 Gy(0.0~6.7 Gy),视交叉0.2 cmn 3的中位剂量为3.6 Gy(2.5~14.8 Gy),左海马Vn 1/3的中位剂量为5.4 Gy(2.1~10.4 Gy),右海马Vn 1/3的中位剂量为4.6 Gy(2.4~12.5 Gy),均低于WBRT组(均n P<0.05)。n 结论:剂量学模拟结果显示,SRT治疗乳腺癌4~9个脑转移瘤时,肿瘤靶区剂量高于WBRT,危及器官受量符合剂量限制要求,部分危及器官受照剂量低于WBRT。“,”Objective:To explore the dosimetric characteristics of whole brain radiotherapy (WBRT) and CyberKnife stereotactic radiotherapy (SRT) in breast cancer patients with 4-9 brain metastases.Methods:The clinical and imaging data of 10 breast cancer patients with 4-9 brain metastases in the Fifth Medical Centre, Chinese PLA General Hospital between March 2015 and November 2015 were retrospectively analyzed. CT and magnetic resonance imaging (MRI) images were imported into the treatment planning system to achieve the fused images for delineating. A radiotherapy treatment plan was designed after delineating the target area. WBRT was administered with two fields, and the prescription dose was 30 Gy in 10 fractions. SRT was administered by the CyberKnife with the prescription dose of 16-18 Gy in one fraction. The volume and dose of the tumor target area, optic nerve, optic chiasm, brain stem, hippocampus and other critical organs were calculated; and radiotherapy dose indexes of WBRT and SRT were compared after conversion to a biological effective dose (BED).Results:The maximum dose (BEDn 4) in the SRT group was higher than that in the WBRT group [(191.0±41.3) Gy vs. (52.5±0.0) Gy, n t = 10.596, n P < 0.01]. The brain tissue and tumor in the target area of WBRT received the same uniform dose of 120.0 Gy. The median maximum dose of BED n 1 of partial organs at risk in the SRT group was lower than that in the WBRT group [(left optic nerve: 3.9 Gy (0.1-11.2 Gy), right optic nerve: 3.9 Gy (0.2-8.9 Gy), optic chiasm: 5.1 Gy (3.8-19.4 Gy); all n P < 0.05]. The median volume dose of BED n 1 in the SRT group were lower than that in the WBRT group (brain stem Vn 1/3: 4.5 Gy (1.9-5.7 Gy), normal brain tissue Vn 2/3: 3.1 Gy (1.3-4.3 Gy), left optic nerve 0.2 cmn 3: 2.7 Gy (0.0-8.8 Gy), right optic nerve 0.2 cmn 3: 3.0 Gy (0.0-6.7 Gy), optic chiasm 0.2 cmn 3: 3.6 Gy (2.5-14.8 Gy), left hippocampus Vn 1/3: 5.4 Gy (2.1-10.4 Gy), right hippocampus Vn 1/3: 4.6 Gy(2.4-12.5 Gy); all n P < 0.05).n Conclusion:The dosimetric simulation results show that SRT for breast cancer patients with 4-9 brain metastases result in a significantly higher dose of the tumor target area and a significantly lower dose of some organs at risk compared with WBRT; and organs at risk meet the requirement of the dose constraints.
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2020年4月3 日,美国临床肿瘤学会( American Society of Clinical Oncology, ASCO)、美国放射肿瘤学会( American Society for Radiation Oncology, ASRO)、美国外科肿瘤学会