实用医学杂志2025，Vol.41Issue(14)：2138-2142,5.DOI:10.3969/j.issn.1006-5725.2025.14.003
组织补偿膜使用方式对乳腺癌根治术后胸壁皮肤剂量的影响
The impact of different bolus application methods on chest wall skin dose after radical mastectomy for breast cancer
摘要
Abstract
Objective To investigate the impact of different application methods of tissue compensators(bolus)on the skin dose delivered to the chest wall following radical mastectomy for breast cancer.Methods A retrospective analysis was conducted on 60 female patients who underwent radical mastectomy and required chest wall radiotherapy at the hospital between January 2023 and March 2025.The Pinnacle3 9.10 radiotherapy planning system(TPS)was utilized to design two VMAT dual semi-arc radiotherapy plans for each patient,with a prescribed target dose of 50 Gy delivered in 2 Gy fractions over 25 sessions.In Plan 1,a Bolus was applied and optimized during the first 15 fractions,and subsequently removed for the remaining 10 fractions without re-optimization.The sub-field configuration and dose weighting from the initial optimization were retained,and only dose recalculations were performed.The final treatment plan combined both the Bolus-included and Bolus-excluded phases.In contrast,Plan 2 involved the application and optimization of Bolus during the first 15 fractions,followed by its removal and re-optimization of the plan for the last 10 fractions.The two optimized plans were then combined for the overall treatment delivery.Data from the two plan groups were analyzed using a paired sample t-test with SPSS 29.0 software.Results There was a statistically significant difference(P＜0.05)in skin Dmean,V52.5,and V55;heart Dmean,V5,V30,and V40;affected lung Dmean,V5,and V20;PRVcord Dmean and Dmax;healthy breast Dmean,V5,and V10;affected humeral head Dmean and V30;as well as PTV Dmean,V50,V55,D2％,D98％,CI,and MU.Moreover,the dose distribution on the target layer and the DVH curves showed marked differences.However,no statistically significant difference was observed in PTV HI(P=0.125).Conclusion The combination of the two optimized plans,consisting of 15 fractions with bolus and 10 fractions without bolus,more accurately reflects the dose distri-bution within the planned target area and organs at risk,thereby providing enhanced protection for the patient's chest wall skin.关键词
组织补偿膜/乳腺癌根治术/胸壁/皮肤剂量Key words
blous/postmastectomy/chest wall/skin dose分类
医药卫生引用本文复制引用
胡作怀,付建东,李小芳,姚欣悦,赵宾,晏涑,何思思..组织补偿膜使用方式对乳腺癌根治术后胸壁皮肤剂量的影响[J].实用医学杂志,2025,41(14):2138-2142,5.基金项目
贵州省自然科学基金项目(编号:黔科合基础-ZK[2022]一般626) （编号:黔科合基础-ZK[2022]一般626）
贵州省卫生健康委科技基金项目(编号:WJW-2024-007) （编号:WJW-2024-007）
贵州省抗癌协会科技计划项目(编号:抗协科计[2023]016) （编号:抗协科计[2023]016）
