VMAT结合CRT治疗胸上段食道癌的剂量学研究  

Dosimetric Study on VMAT Combined With CRT in The Treatment of Upper Thoracic Esophageal Cancer

作　　者：周永强[1] 易金玲[1] 金献测[1] 黄珂靖[1] 吴志勤[1] 韩策[1] 谢聪颖[1] 

机构地区：[1]温州医学院附属第一医院放化疗科,浙江温州325000

出　　处：《中国医学物理学杂志》2013年第2期3973-3977,4011,共6页Chinese Journal of Medical Physics

基　　金：温州市科技局计划项目(Y20120137)

摘　　要：目的:研究容积调强弧形放疗(VMAT)结合适形放疗(CRT)治疗胸上段食道癌的剂量优势。方法:入组10例胸上段食道癌病人,重新为每个病人设计CRT计划,VMAT计划及CRT结合VMAT计划。比较这三种计划方式的剂量分布。结果:CRT的93%(P=0.049)和95%(P=0.02)的处方剂量曲线所覆盖的靶区体积最少。全程VMAT计划具有较好的适形度指数(CI)和适形度数值(CN),对脊髓的保护也最好。CRT结合VMAT最大的优势在于减少了肺部吸收10 Gy(V10,P=0.007),13 Gy(V13,P=0.003),20 Gy(V20,P=0.001)剂量的体积。全程VMAT计划肺部受到30 Gy剂量的体积最小。其他参数比较没有显著差异。结论:CRT结合VMAT治疗胸上段食道癌可以提高靶区覆盖率并减少了肺受照中度剂量的体积。这可能是一种有前景的治疗上段食道癌的方式。Objective： To study the potential benefits of CRT combined with VMAT as the second boost phase in the treatment of upper thoracic esophageal cancer. Methods： Ten patients with upper thoracic esophageal cancer previously treated with CRT combined with a VMAT plan were re-planned with CRT and full VAMT plans. Dosimetric parameters were compared. Results： CRT was inferior in target coverage, as indicated by the volume covered by 93% （p=0.049） and 95% （p=0.02） of the prescription dose. The full VMAT plan was superior in conformal index （CI） and conformal number （CN） and produced the highest protection for the spinal cord. CRT combined with VMAT demonstrated significant advantages in decreasing the volume of the lung irradiated by a dose of 10 Gy （V10, P=0.007）, 13 Gy （V13, P=-0.003）, and 20 Gy （V20, P=0.001）. The full VMAT demonstrated the lowest volume of the lung irradiated by a dose of 30 Gy. Conclusions： CRT combined with VMAT as the second boost phase for upper thoracic esophageal cancer can improve the target coverage and reduce the volume of the lung irradiated by an intermediate dose. This combination may be a promising treatment modality for patients with upper thoracic esophageal cancer.

关 键 词：容积调强弧形放疗 适形放疗 胸上段食道癌 

分 类 号：R730.55[医药卫生—肿瘤]