中国现代医学杂志2026，Vol.36Issue(4)：19-25,7.DOI:10.3969/j.issn.1005-8982.2026.04.004
乳腺癌改良根治术后调强放疗的精细化调整
Refined intensity-modulated radiotherapy planning after modified radical mastectomy for breast cancer
摘要
Abstract
Objective To study the influence of treatment planning system(TPS)parameters on intensity-modulated radiotherapy(IMRT)after modified radical mastectomy for breast cancer.Methods A retrospective analysis was conducted on 14 patients receiving IMRT after modified radical mastectomy for left breast cancer at our hospital from August 2022 to May 2023.For each patient,three parameters in the radiotherapy TPS,including minimum segment area(MSA),minimum monitor unit(MMU),and maximum number of segments(MNOS),were sequentially set to different values.The changes in dosimetric parameters resulting from these adjustments were compared,including the volume receiving 100%of the prescribed dose(V100%),the volume receiving 110%of the prescribed dose(V110%),the conformity index(CI),and the homogeneity index(HI)of the planning target,the left lung volume receiving 5 Gy(LV5),20 Gy(LV20),and 30 Gy(LV30),the mean left lung dose(LDmean),the right lung volume receiving 5 Gy(RV5),the mean right lung dose(RDmean),the heart volume receiving 30 Gy(HV30),the mean heart dose(HDmean),and the maximum spinal cord dose(Cord).Additionally,changes in the plan execution time were evaluated.Results Compared with the initial plan(MSA=4 cm2),the overall monitor units(OMU)decreased with MSA≥9 cm2(P<0.05),plan execution time decreased with MSA≥16 cm2(P<0.05),the overall number of segments(ONOS)decreased with MSA≥49 cm2(P<0.05),and V100%decreased with MSA≥64 cm2(P<0.05).Compared with the initial plan(MMU=5),ONOS decreased with MMU≥12(P<0.05),V110%and RV5 increased and plan execution time decreased with MMU≥15(P<0.05),LV20 increased and V100%and OMU decreased with MMU≥20(P<0.05),CI decreased and Cord increased with MMU≥25(P<0.05).Compared with the initial plan(MNOS=56),changes in ONOS and plan execution time for other MNOS settings were all statistically significant(P<0.05).The variations in ONOS and plan execution time were consistent with the changes in MNOS values.Conclusion Within the constraints of acceptable plan evaluation,appropriately adjusting TPS parameters during IMRT after modified radical mastectomy for breast cancer can improve plan execution efficiency.The maximum values for MSA and MMU can reach 49 and 12,respectively,while MNOS is closely correlated with plan execution time and should be set cautiously.关键词
乳腺癌/最小子野面积/最小机器跳数/最大子野数Key words
left breast cancer/minimum segment area/minimum monitor unit/maximum number of segments分类
医药卫生引用本文复制引用
解小丽,翟小娟,朱玉宏,韦又芳,方敏,张风华..乳腺癌改良根治术后调强放疗的精细化调整[J].中国现代医学杂志,2026,36(4):19-25,7.基金项目
广东省医学科研基金(No:A2024506) （No:A2024506）
