非小细胞肺癌亚临床病变剂量处方的建议  

A Proposal of Dose-prescription for Clinical Target Volume of NSCLC

作　　者：徐池[1] 翟振宇[1] 胡逸民[2] 

机构地区：[1]江苏省肿瘤医院放疗科,南京210009 [2]中国医学科学院北京协和医学院肿瘤研究所肿瘤医院,北京100021

出　　处：《中国生物医学工程学报》2009年第3期433-438,共6页Chinese Journal of Biomedical Engineering

摘　　要：在分析非小细胞肺癌亚临床病变局部侵润规律和低分次大剂量体部立体定向治疗临床结果的基础上,提供一种实体瘤和亚临床病变分开剂量处方的建议,以提高治疗增益。在Varian Eclipse治疗计划系统上,以常规剂量处方调强治疗计划（方案1）作为对照,根据亚临床病变剂量处方的建议,对实体瘤体积大小为131.4 cm的非小细胞肺癌的患者作了调强治疗计划（方案2）。均使用6MV-X射线能量,7个等分角射野,用自编的程序,计算了两个计划的生物等效剂量、归一到2 Gy分次的总剂量、肿瘤控制概率、正常组织并发症概率、和治疗增益。结果表明,方案1和方案2的无并发症肿瘤控制概率（PUTC）分别为44.9%和98.3%,放疗治疗增益比（TG）分别为16.4和30.6。方案1和方案2治疗方案的肿瘤控制概率差异比较明显,尤其对于实体瘤及其邻近的CTV1之计划靶区体积（PCTV1）内的肿瘤控制概率和生物等效剂量,方案2明显高于方案1,但比较肺的V5~V50、平均肺剂量（Dmean）以及等效均匀剂量（EUD）可以认为肺受照射剂量体积基本接近。所提出的GTV、CTV分开剂量处方的建议,可实现治疗方案个体化并使治疗增益获得最大化。Based on the pattern of microscopic tumor extension in NSCLC and the clinical experience of hypofractionated larger dose irradiation for NSCLC, a proposal of dose-prescriptions for NSCLC clinical target volume （CTV） radiation treatment was suggested in order to enhance the therapeutic-gain （TG）. On Varian Eclipse planning system two intensity modulated radiotherapy （IMRT） plans were worked out according to the conventional dose- prescriptions （planl） and the proposed dose-prescriptions （plan2） for a patient receiving IMRT treatment. Both plans used the same 6MV-X rays, equal spaced 7 beams. For comparison, biological effective dose（BED）, normalized to 2 Gy fractionated total dose （NTD）, tumor control probability （TCP）, normal tissue complication probability （NTCP）, and therapeutic gain （TG） were calculated The non-complication TCP（PUTC） and TG were 44.9% ＆ 16.4 for planl, and 98.3% ＆ 30.6 for plan2, respectively. It was showed that for TCP and（BED there was a big difference between two plans especially in GTV and PCTV1 which is closest to （gross tumor volume, GTV）, and obviously plan2 was superior to planl. But in contrast, to the normal lung tissues there was no significant difference between two plans for the comparison items of V5-V50, Mean dose（ Dmean） , EUD and NTCP. That means the total doses irradiated to and volumes of the normal lungs received the dose are almost equal. Therefore, the proposed dose- prescriptions for CTV has the potencial to apply in clinical practice for individualizing the treatment and optimizing the therapeutic gain.

关 键 词：非小细胞肺癌(NSCLC) 亚临床病变(CTV) 剂量处方(DP) 生物等效剂量(BED) 治疗增益(TG) 

分 类 号：R318[医药卫生—生物医学工程]