乳腺癌照射技术中国医学科学院肿瘤医院余子豪乳腺癌放射治疗照射技术的分类全乳腺照射肿块切除或象限切除术+腋窝Ⅰ、Ⅱ水平清扫：LN0或1-3+全乳腺+区域淋巴结照射LN+≥4腋窝淋巴结未作清扫者根治术后胸壁±区域淋巴结照射全乳照射的技术二野切线+楔形板照射三维适形放疗（3D-CRT)正向调强适形放疗（野中野照射，FIF）逆向调强适形放疗（IMRT）常规切线定位乳腺切线照射CLD与受照肺体积CLD(cm)单肺照射体积症状性放射性肺炎1-3——<2%3-3.515-26%——>4cm30%10%肺耐受量V25Gy25%图14-0-11锁骨上野半野照射技术示意图图14-0-12转动治疗床使切线野上界与锁骨上野下界重合乳腺二野切线+楔形板照射的疗效局部控制率：20年复发率NSABP-062.7%；VERONENSi8.8%,EBCTCG5.9%美容效果好:Excellent75%,Good23%,Poor2%并发症少:乳腺纤维化(3°)0.7%；症状性放射性肺炎0.6%；肋骨骨折<1%；臂丛N损伤0.2%；软组织坏死0.8%对侧乳腺癌发病率与手术治疗同存在问题：乳腺靶区内剂量分布不均匀，心、肺组织受到一定剂量照射乳腺癌照射技术改进的目标提高靶区内剂量分布的均匀性减少心脏受照射的体积和剂量不增加对侧乳腺的照射剂量乳腺IMRT乳腺IMRT体位固定装置Breastboards:CT-compatibleThisbreastboardisdesignedtofitthroughaCT-apetureforconsistentpatientpositioningfromimagingthroughtreatment.WingboardsTheWingboardconsistsofpolycarbonatematerialwithheadandarmrests.Two-partfoamcradlesTwo-partfoamcradlesuseachemicalprocessinvolvingtwocanistersofmixableliquidswhichwhencombinedexpandandhardenintoafirmcradle.VacuumcushionsFilledwithtinypolystyrenebeads,vacuumcushionscreatearigidandcomfortablecradlearoundthepatientwhenavacuumisdrawn.Vacuumcushionscomeinaurethaneoranylon-reinforcedmaterial.CT模拟定位及靶区勾画乳腺区域淋巴引流区腋窝：Ⅰ，Ⅱ，Ⅲ水平内乳区锁骨上淋巴结EPID验证WedgesIMRTsIMRT/wedgePTVD0549.9±0.6Gy48.4±1.0Gy96.9±1.3%V9596.6±1.9%97.1±1.9%100.6±1.0%Max.52.0±1.2Gy50.3±1.6Gy96.7±1.8%LungD0546.6±2.2Gy44.7±2.0Gy96.0±0.9%V1007.0±2.8%4.8±2.8%64.9±14.9%Max.50.2±0.9Gy47.9±0.6Gy95.5±1.2%HeartD0520.8±12.5Gy19.7±12.6Gy92.1±10.6%V951.8±1.2%1.3±1.1%66.1±24.7%Max.47.8±1.2Gy46.0±0.9Gy96.2±1.4%ContralateralBreastD052.8±0.8Gy1....
