内乳淋巴结清扫术后患者内乳靶区不同勾画方法比较研究

doi:10.3760/cma.j.cn113030-20210204-00062

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摘要目的以内乳淋巴结清扫(ImlND)前勾画的内乳淋巴结临床靶区(CTVImlN)为参照,对比不同勾画方法构建的ImlND术后CTVImlN靶区间差异,探讨ImlND后CTVImlN勾画的合理方法。方法选取已行患侧ImlND且术前、术后CT图像资料完整的乳腺癌改良根治术(MRM)患者 20例。依据RTOG指南在术前CT图像上勾画健侧及患侧CTVImlN (CTVpr-I、CTVpr-a)。在术后CT图像上分别采用形变配准(DIR)法、视觉对照法、精确测量法勾画术后患侧CTVImlN,并分别命名为CTVDIR、CTVV、CTVM。比较CTVV、CTVM、CTVDIR与CTVpr-a间靶区中心间距、靶区体积以及3种不同方式构建的CTVImlN的适形指数(CI)及包含度(DI)差异。结果 CTVV、CTVM、CTVDIR与CTVpr-a的靶区中心间距分别为2.17、1.44、1.25cm。CTVpr-a、CTVpr-I、CTVV、CTVM和CTVDIR的靶体积分别为2.10、2.17、2.04、1.88、2.07cm³(均 P>0.05)。CTVV-CTVpr-a间、CTVM-CTVpr-a间CI均为0.16,CTVDIR-CTVpr-a间CI为0.43,明显高于前两者(均 P<0.01)。CTVV-CTVpr-a、CTVM-CTVpr-a间DI分别为0.26和0.24,CTVDIR-CTVpr-a间DI为0.58,明显高于前两者(均 P<0.01)。结论准确勾画ImlND术后的CTVImlN是困难的,但相比较而言,DIR法所勾画靶区的空间位置适配度优于视觉对照法和精确测量法。

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关键词 ：内乳淋巴结清扫术, 乳腺肿瘤/放射疗法, 靶区勾画

Abstract：Objective To compare the differences of postoperative clinical target volume of internal mammary lymph node (CTVImlN) by different delineation methods, and to explore the reasonable method of CTVImlN delineation after internal mammary lymph node dissection (ImlND). Methods A total of 20 breast cancer patients who had undergone modified radical mastectomy(MRM) with ImlND on the affected side and had complete preoperative and postoperative CT images were selected. The CTV (CTVpr-I, CTVpr-a) of both sides of ImlN were delineated on preoperative CT images according to RTOG guideline. On postoperative CT images, three different methods including deformation image registration (DIR) method, visual contrast method and precise measurement method, were employed to delineate the postoperative CTVImlN of the affected side. The targets were named as CTVDIR, CTVV and CTVM, respectively. The central displacement, target volume, degree of inclusion (DI) and conformity index (CI) of CTVpr-a, CTVV, CTVM and CTVDIR were compared. Results The central displacement of CTVV, CTVM and CTVDIR from CTVpr-a was 2.17cm, 1.44cm and 1.25cm,respectively. The target volume of CTVpr-a, CTVpr-I,CTVV, CTVM and CTVDIR was 2.10cm³, 2.17cm³, 2.04cm³, 1.88cm³ and 2.07cm³ respectively. There was no significant difference in the target volume (all P>0.05). The CI values of CTVV-CTVpr-a and CTVM-CTVpr-a were both 0.16, and that of CTVDIR-CTVpr-a was 0.43. The CI value of CTVDIR was significantly higher than those of CTVV and CTVM (both P<0.01). The DI values of CTVV-CTVpr-a, CTVM-CTVpr-a and CTVDIR-CTVpr-a were 0.26, 0.24 and 0.58, respectively. The DI value of CTVDIR was significantly higher than those of CTVV and CTVM (both P<0.01). Conclusions It is difficult to accurately delineate the CTVImlN for patients after ImlND. However, the spatial position fitness of the target region delineated by DIR method is better than those by visual contrast and precise measurement methods.

Key words： Internal mammary lymph node dissection Breast Neoplasm/radiotherapy Target delineation

收稿日期: 2021-02-04

基金资助:山东省自然科学基金(ZR2020QH260);山东省泰山学者计划(ts20190982)

通讯作者: 李建彬,Email:lijianbin@msn.com;王玮,Email:w.wei1103@163.com

作者简介: 王雪现在天津师范大学校内医院300387

引用本文:

王雪,王玮,李建彬等. 内乳淋巴结清扫术后患者内乳靶区不同勾画方法比较研究[J]. 中华放射肿瘤学杂志, 2021, 30(11): 1136-1141.

Wang Xue,Wang Wei,Li Jianbin et al. Comparison of different delineation methods of clinical target volume of internal mammary lymph node for patients after internal mammary lymph node dissection[J]. Chinese Journal of Radiation Oncology, 2021, 30(11): 1136-1141.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.cn113030-20210204-00062 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2021/V30/I11/1136

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