Wang Jiaqi, Ji Haitao, Zhang Shilin, Guo Xu, Fu Tianyi, Zhao Lisong, He Chunbo
Department of Radiotherapy, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
Department of Radiotherapy, 961 Hospital of the PLA Joint Logistic Support Force, Qiqihar, People's Republic of China.
Curr Med Imaging. 2023 Feb 22. doi: 10.2174/1573405619666230222093137.
Background Breast cancer is the most common malignant tumour in women. Radical mastectomy with postoperative radiotherapy is now the standard treatment for locally advanced breast cancer. Intensity-modulated radiotherapy (IMRT) has now been developed, which employs linear accelerators to deliver precise radiation to a tumour while minimizing the dose to surrounding normal tissue. It significantly improves the efficacy of breast cancer treatment. However, there are still some flaws that must be addressed. Objective To assess the clinical application of the three-dimensional (3D)-printed chest wall conformal device for breast cancer patients who need to be treated by chest wall intensity modulated radiotherapy (IMRT) after radical mastectomy. Methods The 24 patients were divided into three groups. During a computed tomography (CT) scan, patients in the study group were fixed by a 3D-printed chest wall conformal device, nothing in control group A, and a traditional 1-cm thick silica gel compensatory pad on the chest wall in control group B. The parameters of mean Dmax, Dmean, D2%, D50%, D98%, the conformity index (CI), and the homogeneity index (HI) of the planning target volume (PTV) are compared. Results The study group had the best dose uniformity (HI = 0.092) and the highest conformation (CI = 0.97), the worst in control group A (HI = 0.304, CI = 0.84). The mean Dmax, Dmean, and D2% of the study group were lower than control groups A and B (p<0.05). The mean D50% was higher than control group B (p<0.05), while the mean D98% was higher than control groups A and B (p<0.05). The mean Dmax, Dmean, D2%, and HI of control group A were higher than control group B (p<0.05), whereas the mean D98% and CI were lower than control group B (p<0.05). Conclusion By improving the efficacy of postoperative radiotherapy for breast cancer, using 3D-printed chest wall conformal devices may greatly improve the accuracy of repeating position fixation, increase the dose on the skin surface of the chest wall, optimise the dose distribution of the target area, and thus further reduce tumour recurrence and prolong patients' survival.
背景 乳腺癌是女性最常见的恶性肿瘤。根治性乳房切除术加术后放疗是目前局部晚期乳腺癌的标准治疗方法。现在已经开发出调强放疗（IMRT），它使用直线加速器向肿瘤提供精确的辐射，同时将对周围正常组织的剂量降至最低。它显著提高了乳腺癌治疗的疗效。然而，仍然存在一些必须解决的缺陷。目的 评估三维（3D）打印胸壁适形装置在根治性乳房切除术后需要进行胸壁调强放疗（IMRT）的乳腺癌患者中的临床应用。方法 将24例患者分为三组。在计算机断层扫描（CT）扫描期间，研究组患者使用3D打印胸壁适形装置固定，A对照组不做处理，B对照组在胸壁上使用传统的1厘米厚硅胶补偿垫。比较计划靶区（PTV）的平均Dmax、Dmean、D2%、D50%、D98%、适形指数（CI）和均匀性指数（HI）等参数。结果 研究组的剂量均匀性最佳（HI = 0.092），适形性最高（CI = 0.97），A对照组最差（HI = 0.304，CI = 0.84）。研究组的平均Dmax、Dmean和D2%低于A、B对照组（p<0.05）。平均D50%高于B对照组（p<0.05），而平均D98%高于A、B对照组（p<0.05）。A对照组的平均Dmax、Dmean、D2%和HI高于B对照组（p<0.05），而平均D98%和CI低于B对照组（p<0.05）。结论 通过提高乳腺癌术后放疗的疗效，使用3D打印胸壁适形装置可能会大大提高重复定位固定的准确性，增加胸壁皮肤表面的剂量，优化靶区的剂量分布，从而进一步降低肿瘤复发率并延长患者生存期。
