乳腺癌根治术后胸壁放疗技术及剂量分布.docVIP

乳腺癌根治术后胸壁放疗技术及剂量分布 　关键词：乳腺癌根治术放射治疗 　　摘要:乳腺癌根治术后病人CT图像送入三维治疗计划系统,观察6MVX线切线照射及电子线垂直照射胸壁时的剂量分布。包括内乳淋巴结和不包括内乳淋巴结的6MVX线切线照射无需楔形板;单纯电子线垂直照射,即使是6MeV低能电子线,肺组织受照亦相当严重;6MeV电子线配合皮肤表面填0.5cm厚组织等效物,肺组织受照较小,皮肤剂量提高,但内乳淋巴结与其表面皮肤剂量不能两者兼顾;9MeV电子线配合皮肤表面填不等厚度组织等效物,可使得90%等效剂量包括皮肤、胸壁和内乳淋巴结而肺组织受照很少;对皮肤和内乳淋巴结均需高量照射者,电子线配合皮肤表面填组织等效物垂直照射较X线切线照射有明显优势。 　　 Chestwallradiotherapytechniqueanddosedistributionforpatientsofbreastcancerafterradicalmastectomy 　　AbstractSendingtheCTimagesofthepatientsofbreastcancerafterradicalmastectomytoCADPLAN3DTPS,studyingthedosedistributionof6MVX-raytangentialirradiationanddifferentenergyelectronrayperpendicularirradiationtochestwall.Someresultswerepresented.Includingornotincludingtheintramammarylymph.Itisnotnecessaryfor6MVXbeamtangentialirradiationtochestwallofthepatientofbrestcancerafterradicalmastectomy.Perpendicularirradiationby6MVelectronbeamonlytheirradiationofthelungisseriousandthedoseoftheskinislow.Perpendicularirradiationby6MVelectronbeamwith0.5cmbolusascompensator,itcanreducetheirradiationofthelungandmakedoseoftheskinhighbutitwillreducethedoseofintramammarylymphifaboveittheskinisoverlaidofbolus.Perpendicularirradiationby9MeVelectronbeamwithunequalthicknessbolusoverlaidontheskin,itcanmake90%isdoselineinvolvingtheskinchestandintramammarylymphbutthelungwhichisirradiatedissmall.IfbothskinandintramammarylymphneedhighdoseirradiationperpendicularirradiationbyelectronbeamwithbolusascompensatorhasthesignificantsuperioritythanXbeamtangentialirradiation. 　　Keywordsbreastcancer;radicalmastectomy;radiotherapy;dosedistribution 　　乳腺癌根治术后,如局部肿瘤较晚,皮肤有水肿、破溃、红斑或与胸肌固定,腋窝淋巴结有严重转移时,均需作胸壁放疗,术后胸壁的厚度一般在1.5～2cm,原则上可用Co-60或4～6MVX线作切线照射或或适当能量电子线垂直照射。针对于保留乳腺作放疗X线切线照射技术及剂量学问题已有相当完善的研究(1-5。本文旨在对乳腺癌根治术后胸壁放疗的不同技术的剂量分布进行探讨,以便临床根据不同病变情形,选择最佳治疗方案。 表1乳腺癌根治术后胸壁放疗技术与剂量分布 　胸壁剂量%内乳淋巴结点剂量（%）肺组织受照深度(cm) 最大最小平均90%等剂量线70%等剂量线50%等剂量线 6MVX线切线野（包括内乳点）105.677.392.170～1002.43.03.3 6MVX线切线野（不包括内乳点）10774.792　1.52.12.5 6MeV10074.489.6＞902.73.64.5 6MeV+0.5cm组织补偿块100＞9096.250～900.51.52.0 9