不同乳癌放射治療技術在心臟劑量之探討

The Cardiac dose Analysis in Breast Cancer Radiotherapy by Different Technology

邱筱文(HSIAO-WEN CHIU)

指導教授 ： 陳信雄

中臺科技大學/健康科學院/醫學影像暨放射科學系暨研究所/碩士(2018年)

摘要

本研究主要討論左側乳癌病患放射治療，處方劑量為50 Gy，治療25次，並使用3D順形治療﹙three- dimensional conformal radiation therapy，3D-CRT﹚、強度調控放射治療﹙intensity-modulated radiation therapy，IMRT﹚及體積調控弧形放射治療（volumetric modulated radiation therapy，VMAT）三種方式進行分析，探討其計畫靶體積、心臟之劑量分布與劑量體積直方圖(DVH)之變化，依研究結果數據進行討論分析。
結果顯示，靶體積平均劑量VMAT技術平均劑量及標準差為49.63±1.13 Gy，IMRT技術平均劑量及標準差為49.34±1.85 Gy，3D-CRT技術平均劑量及標準差為43.75±5.51 Gy﹙p=0.015﹚，有顯著差異。在V47.5中，VMAT技術平均體積及標準差為88.64±9.83%，IMRT技術平均體積及標準差為84.4±9.48%，3D-CRT技術平均體積及標準差為55.48±18.27%﹙p=0.001﹚，有顯著差異。
在靶體積順形指數(CI)中，VMAT技術為0.05±0.03，IMRT技術為0.05±0.04，3D-CRT技術為0.03±0.0.03﹙p=0.282﹚。靶體積均勻度(HI)中VMAT技術為0.28±018，IMRT技術為0.41±0.14，3D-CR技術為0.87±0.18 ﹙p=0.000﹚，以VMAT技術為佳。在心臟平均劑量中VMAT技術為12.84±3.7 Gy，IMRT技術為14.8±7.22 Gy，3D-CRT技術為8.98±3.64 Gy﹙p=0.171﹚。以V30來看，VMAT技術平均體積及標準差為9.31±6.97%，IMRT技術平均體積及標準差為18.4±11.96%，
3D-CRT技術平均體積及標準差為12.78±7.38%﹙p=0.246﹚。以V15來看，VMAT平均體積及標準差為28.2±11.92%，IMRT技術平均體積及標準差為33.1±17.47%，3D-CRT技術平均體積及標準差為18.33±8.12%﹙p=0.019﹚。以V5來看，VMAT平均體積及標準差為79.75±23.47%，IMRT技術平均體積及標準差為63.69±12.83%，3D-CRT技術平均體積及標準差為27.57±10.3%﹙p=0.005﹚。
此研究顯示降低心臟高劑量區體積，及提高腫瘤劑量均勻性，增加控制率，VMAT技術為較佳的治療方式。

關鍵字

乳癌 ； 三度空間順形治療 ； 強度調控放射治療 ； 體積調控弧形放射治療 ； 心臟劑量

並列摘要

This study focused on radiation therapy for patients with left breast cancer, prescribed doses of 50 Gy, 25 treatment fractions, and using 3D-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric modulated radiation therapy (VMAT) were used to analyze the target volume, cardiac dose distribution and dose volume histogram (DVH), and discussed according to the results of the study. analysis.
The results showed that the average dose and standard deviation of the target volume mean VMAT technique was 49.63±1.13Gy, the average dose and standard deviation of IMRT technique were 49.34±1.85Gy, and the average dose and standard deviation of 3D-CRT technique was 43.75±5.51Gy (p= 0.015), there is a significant difference. In V47.5, the average volume and standard deviation of VMAT technology is 88.64±9.83%, the average volume and standard deviation of IMRT technology is 84.4±9.48%, and the average volume and standard deviation of 3D-CRT technology is 55.48±18.27% (p=0.001). ), there are significant differences. In the target volume conformal index (CI), the VMAT technique was 0.05 ± 0.03, the IMRT technique was 0.05 ± 0.04, and the 3D-CRT technique was 0.03 ± 0.0.03 (p=0.282). In the target volume uniformity (HI), the VMAT technique is 0.28±018, the IMRT technique is 0.41±0.14, and the 3D-CR technique is 0.87±0.18 (p=0.000). The VMAT technique is preferred. The VMAT technique was 12.8 ± 3.7 Gy in the average heart dose, 14.8 ± 7.2 Gy in the IMRT technique, and 8.98 ± 3.64 Gy in the 3D-CRT technique (p=0.171). From the perspective of V30, the average volume and standard deviation of VMAT technology is 9.31±6.97%, the average volume and standard deviation of IMRT technology is 18.41±11.96%, and the average volume and standard deviation of 3D-CRT technology is 12.78±7.38% (p=0.246). . In terms of V15, the average volume and standard deviation of VMAT were 28.2±11.92%, the average volume and standard deviation of IMRT technique were 33.1±17.47%, and the average volume and standard deviation of 3D-CRT technique was 18.33±8.12% (p=0.019). In terms of V5, the average volume and standard deviation of VMAT were 79.75±23.47%, the average volume and standard deviation of IMRT technique were 63.69±12.83%, and the average volume and standard deviation of 3D-CRT technique was 27.57±10.3% (p=0.005). This study showed that reducing the high dose volume of the heart, increasing the uniformity of tumor dose, and increasing the control rate, VMAT technique is the preferred treatment.

並列關鍵字

breast cancer ； 3D-CRT ； IMRT ； VMAT ； heart dose

參考文獻

[1]衛生福利部國民健康署 乳癌防治https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=205&pid=1124

[2]衛生福利部國民健康署癌症登記線上互動查詢系統https://cris.hpa.gov.tw/pagepub/Home.aspx?itemNo=cr.q.30

[3]衛生福利部105年國人死因統計結果https://www.mohw.gov.tw/cp-16-33598-1.html

[4]Chui C.S., Hong L., McCormick B. Intensity-modulation radiotherapy technique for three-field breast treatment. Int J Radiat Oncology Biol Phys 2005;62:1217-1223.

[5]Muren L.P., Masurstad G., Hafslund R., et al. Cardiac and pulmonary dose and complication probabilities in standard and conformal tangential irradiation in conservative management of breast cancer. Radiotherapy and Oncology 2002;62:173-183.