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目的 探讨容积调强放疗(VMAT)与传统三维适形放疗(3D-CRT)在乳腺癌根治术后放疗中对心脏及肺组织的保护作用。方法 回顾性分析铜陵市人民医院肿瘤科2022年1月～2024年12月收治的118例根治术后患者，其中60例接受VMAT治疗，58例接受3D-CRT治疗，所有患者均采用瓦里安Clinac IX加速器，靶区剂量统一为50 Gy/25次。结果 剂量学分析显示，VMAT组较3D-CRT组显著降低心脏平均剂量、心脏V20及左前降支最大剂量，差异有统计学意义(t=5.12、4.78、6.33,P<0.001)。肺组织保护方面，VMAT组同侧肺V20、全肺平均剂量及对侧肺V5均显著优于3D-CRT组，差异有统计学意义(t=5.89、4.67、3.98,P<0.001)。治疗效率方面，VMAT组治疗时间较3D-CRT组缩短、靶区均匀性指数(HI)提升，差异有统计学意义(t=5.78、4.56,P<0.001)。结论 VMAT较3D-CRT可显著降低心脏及肺组织受照剂量，推荐作为根治术后放疗优选方案。
Abstract：Objective This study aimed to compare the protective effects of volumetric modulated arc therapy(VMAT)versus 3D conformal radiotherapy(3D-CRT)on cardiac and pulmonary tissues in postoperative radiotherapy for radical mastectomy. Methods A retrospective analysis was conducted on 118 radical mastectomy patients treated in the Department of Oncology, Tongling People's Hospital, from January 2022 to December 2024. Among them, 60 patients received VMAT,and 58 received 3D-CRT. All patients were treated using a Varian Clinac IX accelerator with a uniform prescription dose of 50 Gy in 25 fractions. Results Dosimetric analysis revealed that the VMAT group significantly reduced cardiac mean dose, cardiac V20,and maximum dose to the left anterior descending artery(t=5.12,4.78,6.33,P < 0.001),respectively. For pulmonary protection, the VMAT group showed superior ipsilateral lung V20,mean lung dose, and contralateral lung V5(t=5.89,4.67,3.98,P < 0.001). Treatment efficiency improved significantly with VMAT and enhancing homogeneity index(HI)(t=5.78,4.56,P < 0.001). Conclusion VMAT significantly reduces cardiac and pulmonary radiation exposure compared to 3D-CRT,which is recommended as the optimal radiotherapy strategy for radical mastectomy patients.
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基本信息:
中图分类号:R737.9
引用信息:
[1]朱大高,卢春静,王俊杰,等.乳腺癌术后容积调强放疗对心脏和肺组织的保护作用研究[J].中华保健医学杂志,2026,28(01):25-28.
基金信息:
安徽省卫健康科研项目(AHWJ2024BAn30004)
2025-04-17
2025
2025-10-23
2025
1
2026-01-21
2026-01-21