黎艳萍, 王晓红, 李莹, 李俊玉, 谭文勇, 胡德胜. 危及器官边界在估计心脏亚结构照射剂量中的作用[J]. 中国肿瘤临床, 2014, 41(3): 194-199. DOI: 10.3969/j.issn.1000-8179.20131395
引用本文: 黎艳萍, 王晓红, 李莹, 李俊玉, 谭文勇, 胡德胜. 危及器官边界在估计心脏亚结构照射剂量中的作用[J]. 中国肿瘤临床, 2014, 41(3): 194-199. DOI: 10.3969/j.issn.1000-8179.20131395
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LI Yanping, WANG Xiaohong, LI Ying, LI Junyu, TAN Wenyong, HU Desheng. Estimated radiation dose to cardiac substructures and their corresponding planning risk volumes[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2014, 41(3): 194-199. DOI: 10.3969/j.issn.1000-8179.20131395
Citation: LI Yanping, WANG Xiaohong, LI Ying, LI Junyu, TAN Wenyong, HU Desheng. Estimated radiation dose to cardiac substructures and their corresponding planning risk volumes[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2014, 41(3): 194-199. DOI: 10.3969/j.issn.1000-8179.20131395
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危及器官边界在估计心脏亚结构照射剂量中的作用

Estimated radiation dose to cardiac substructures and their corresponding planning risk volumes

    摘要
  • 摘要:
      目的  探讨心脏亚结构(CS)的计划危及体积(PRV)在左乳癌调强放疗(IMRT)中估计CS照射剂量的作用。
      方法  勾画23例左乳腺癌保乳后IMRT患者的CS, 以CS的平均运动幅度为外放边界建立PRV。设计2个不同的IMRT计划并计算CS及PRV的体积、平均剂量、最大剂量(D2%)和标准差, 并计算CS和其PRV的平均剂量、D2%的差别。
      结果  与CS本身相比, 心脏和左心室PRV体积增加50%~80%, 冠状动脉主干及主要分支PRV体积增加18.7~42.6倍。在两个不同IMRT计划中, 心脏、心脏前壁区域(AMT)、前降支及相应的PRV的平均剂量分别为9.4~11.4 Gy、11.0~17.5 Gy、22.6~27.8 Gy, 其D2%分别为24.5~36.2 Gy、28.2~38.8 Gy、36~45 Gy。冠状动脉左右主干、右缘支和左旋支的平均剂量为8.6~14.9 Gy, D2%为12.5~23.7 Gy。与CS的剂量相比, 相应的PRV的平均剂量差别为-2.5%~12.5%, D2%增加了8.0%~43.1%。多数CS的PRV剂量的标准差明显增大。
      结论  在左乳癌保乳后IMRT中CS和相应PRV的平均剂量差别 < 12%。

     

    Abstract:
      Objective  To investigate the role of planning risk volume (PRV) in estimating the radiation dose for various cardiac substructures (CS).
      Methods  The CS of 23 patients with left-sided breast cancer who underwent postoperative intensity-modulated radiotherapy (IMRT) was delineated.PRV was expanded from CS with an additional margin determined by the mean amplitude of cardiac motion.Two IMRT plans were designed.The volume, mean dose, maximal dose (D2%), and standard deviation of CS and its PRV were calculated.
      Results  In comparison to the volume of CS, the PRV of the heart, specifically the left ventricle, increased by 50% to 80%, whereas the PRV of the main coronary arteries and sub-branches increased by 18.7 times to 42.6 times.In the two IMRT plans, the mean dose to the heart, anterior myocardial territory, anterior descending artery, and their corresponding PRVs ranged from 9.4 Gy to 11.4 Gy, 11.0 Gy to 17.5 Gy, and 22.6 Gy to 27.8 Gy, respectively.The D2% to CS and its PRV was 24.5 Gy to 36.2 Gy, 28.2 Gy to 38.8Gy, and 36 Gy to 45 Gy.The mean dose and D2% to the coronary arteries, including both left and right main coronary arteries, right marginal artery, and left circumflex artery, were 8.6 Gy to 14.9 Gy and 12.5 Gy to 23.7 Gy, respectively.The difference of the mean dose and D2% to CS and its corresponding PRVs was 2.5% to 12.5% and 8.0% to 43.1%, respectively.Compared with the standard deviation of the radiation dose to CS, majority of the standard deviation to PRVs increased significantly.
      Conclusion  The radiation dose difference between CS and its corresponding PRVs is < 12%.

     

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