术后乳房保护放射治疗中的心脏基结构剂量测量:使用MONACO进行内部乳腺节辐射的新的8场IMRT方法
Ziyi Xie1, Shuai Hao2, Xiao Wu1
1Department of Oncology, Hebei Medical University Third Hospital, Shijiazhuang, China.
Frontiers in oncology
|February 5, 2026
概括
在乳腺癌放射治疗中包括内部乳腺淋巴结 (IMN) 增加左侧病例的心脏剂量,增加心脏毒性风险. 右侧治疗没有显示显著的心脏剂量差异,这表明对左侧恶性瘤进行了仔细的风险评估.
科学领域:
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
- 心血管健康 心血管健康
背景情况:
- 内部乳腺淋巴结 (IMN) 辐射是乳房保护放射治疗 (BCRT) 的组成部分.
- 含有IMN对心脏基结构的剂量计影响需要仔细评估,特别是在左侧乳腺癌中.
研究的目的:
- 评估包括IMN与排除IMN在BCRT中的心脏亚结构上的剂量测量效应.
- 提供关于术后乳腺癌患者IMN照射的知情临床决策的证据.
主要方法:
- 20名乳腺癌患者 (10名左侧,10名右侧) 接受了8场强度调节辐射疗法 (IMRT).
- 目标体积包括乳房,关节骨上和IMNs; 风险器官包括心脏及其基层结构.
- 对IMN纳入与排除策略进行了比较剂量测量分析.
主要成果:
- 在左侧乳腺癌中,IMN辐射显著增加了心脏平均剂量和心脏基结构暴露.
- 右侧乳腺癌治疗没有显示平均心脏剂量或LAD动脉剂量的显著差异.
- 在非IMN队列中,规划目标体积的均性和一致性在左侧和右侧癌症中得到改善.
结论:
- 左侧BCRT中的IMN辐射增加了心脏剂量,可能会增加长期心血管风险;右侧治疗没有显著增加心脏剂量.
- 当前的放射治疗规划指标可能无法完全捕捉辐射诱导的心脏毒性风险;建议进行全面的心脏亚结构评估.
- 临床决策必须平衡局部区域控制与潜在心脏毒性,特别是左侧乳腺癌,考虑先进的放射治疗技术.
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