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心脏子结构剂量降低和毒性风险评估:IMPT与乳腺癌IMRT对比

Lu Cao^1,2, Han Zhao^1,2, Shujun Zhang^1,2

¹Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

International journal of particle therapy

|June 30, 2025

概括

与强度调节辐射疗法 (IMRT) 相比,强度调节质子疗法 (IMPT) 显著降低了心脏基结构剂量. 这种先进的辐射技术提供了相当大的心脏保护,特别是在左侧乳腺癌治疗中.

科学领域:

辐射瘤学辐射瘤学
医学物理医学物理
心脏病学心脏病学

背景情况:

强度调节辐射疗法 (IMRT) 是乳腺癌的标准治疗方法,但仍然存在对心脏辐射剂量引起的心脏毒性的担忧.
强度调节质子疗法 (IMPT) 假设可以提供更好的剂量分配,并可能降低心脏风险.
仅有有限的数据可以比较IMPT和IMRT之间的心脏基结构剂量和相关的毒性风险.

研究的目的:

在乳腺癌患者中,评估IMPT与IMRT相比,IMPT在心脏基结构中实现的剂量降低.
通过正常组织并发症概率 (NTCP) 模型评估潜在的心脏毒性风险降低.
专门分析左侧和右侧内部乳腺节辐射 (IMNI) 的剂量减少.

主要方法:

从IMRT手臂对30名乳腺癌患者进行了回顾性分析,这些患者的平均心脏剂量 (MHD) 是最高的.
开发IMPT计划的规定的剂量为4005cGy (RBE) 在15个分数.
利用两个NTCP模型 (Darby和Bogaard) 来比较IMPT和IMRT计划之间的个人急性冠状动脉事件 (ACE) 风险.

主要成果:

IMPT将心脏基结构剂量降低了63.34%至100%,左侧患者的绝对降低更大.
对于左侧IMNI,IMPT显著降低了对左前垂下冠状动脉 (82.25%) 和右心室 (79.45%) 的剂量.
根据NTCP模型,IMPT可以将个人ACE风险降低1.58%5.16%的左侧IMNI和0.59%1.05%的右侧IMNI.

结论:

IMPT通过大幅降低对心脏基结构的辐射剂量,证明了显著的心脏保护.
这些发现表明心脏毒性风险降低,特别是在接受左侧IMNI的患者中.
IMPT是一种有前途的辐射疗法,可最大限度地降低乳腺癌患者的心脏风险,特别是那些具有高风险概况的患者.

关键词:

心脏子结构是指心脏的子结构.对心脏有毒性的心脏毒性强度调节的质子疗法强度调节的质子疗法.正常组织并发症概率模型辐射剂量辐射剂量

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