中心型NSCLC常规分割适形放疗与同期加量适形放疗剂量学比较  

Comparison of dosimetric distribution between the conventional fracion radiotherapy and simultaneous integrated boost conformal radiotherapy for center type non-small cell lung cancer

作　　者：李静[1] 周志国[1] 乔学英[1] 曹彦坤[1] 宋玉芝[1] 杨立鑫[1] 郭莹[1] 甄婵军[1] 

机构地区：[1]河北医科大学第四医院放疗五科,河北石家庄050011

出　　处：《中华肿瘤防治杂志》2013年第16期1245-1248,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：河北省普通高校强势特色学科肿瘤学建设基金(2005-52);河北省科技厅支撑计划项目(12276104D-17)

摘　　要：目的:比较局部晚期中心型非小细胞肺癌同期加量适形放疗和常规分割适形放疗计划的剂量分布。方法:收集经病理确诊的局部晚期非小细胞肺癌患者10例,每例患者均设计2个放疗计划。1)常规分割适形放疗计划(conven-tional fractionation radiotherapy,CFR):计划靶体积(planning target volume,PTV)照射剂量60Gy/30次;2)同期加量适形放疗计划(SIB-CR):PTV处方剂量50.4Gy/28次,临床靶体积(clinic target volume,CTV)处方剂量64.4Gy/28次。比较2种放疗计划的靶区剂量及肺、食管、脊髓和心脏等危及器官受量。结果:SIB-CR组较CFR组的大体肿瘤体积(gross tumor volume,GTV)D90、GTV D95分别增加了(1.777 0±0.200 5)Gy(P=0.005)、(1.757 0±0.135 9)Gy(P=0.008),差异均有统计学意义。SIB-CR组肺平均剂量、V5、V8、V10、V13、V20、V30、V40、V50和V55均小于CFR组,其中肺平均剂量、V8、V10、V13、V20、V30、V40和V50差异均有统计学意义,P<0.05。SIB-CR组脊髓最大剂量、平均剂量、V40及正常组织并发症概率(normal tissue complication probability,NTCP)均小于CFR组,其中脊髓最大剂量比较差异有统计学意义,P=0.022。SIB-CR组的食管最大剂量、平均剂量、食管V45、食管全周受照45Gy长度(LETT45)均小于CFR组,其中平均剂量、V45差异有统计学意义,P值分别为0.002和0.003。SIB-CR组的心脏最大剂量、平均剂量、V40均小于CFR组,差异无统计学意义,P>0.05。结论:SIB-CR较CFR能获得更高的肿瘤剂量,且能降低肺、脊髓、食管和心脏等危及器官受量,但还有待于进一步的临床研究。OBJECTIVE： To compare the dose distribution between conventional fractionation radiotherapy （CFR） and simultaneous integrated boost conformal radiotherapy （SIB-CR） in locally advanced non-small cell lung cancer. METHODS： Ten patients with locally advanced non-small cell lung cancer were collected. Two different radiation treat- ment plans were designed for each patient. Conventional fractionation radiotherapy （CFR） ：PTV was given 60 Gy in 30 fractions. Simultaneous integrated boost conformal radiotherapy （SIB-CR） ：PTV was given 50.4 Gy in 28 fractions,and CTV1 was given 64.4 Gy in Z8 fractions simultaneously. The two plans were evaluated by dose distribution of the targets and OARs such as lung,esophagus,spinal cord and heart. RESULTS： The GTV D90 and GTV D9 SIB-CR plans were （1. 777 0±0. 200 5） Gy and （1. 757 0±0. 135 9） Gy respectively which was higher than CFR plans （P〈0.05）. For mean lung dose, V5, V8, V10, V13, V20, V30, V40, V50 and V55, SIB-CR plan was lower than those CFR plan, the difference was statistically significant except V5 and V55 between two plans （P〈0.05）. Comparing to the CFR plans,SIB-CR plans were lower in maximum dose, mean dose, V40 and NTCP of spinal cord,maximum dose, mean dose, V4 and LETT4s of esopha gus. The difference was statistically significant in maximum dose of spinal cord and mean dose, V45 of esophagus（P〈0.05）. For maximum dose,mean dose,V40 of heart,SIB-CR plan was lower than those CFR plan （P〉0.05）. CONCLUSIONS： SIB-CR planning conferred higher dose coverage for tumor target and lower dose for lung,spinal cord, esophagus and heart. It needs to be evaluated further in clinical trials.

关 键 词：非小细胞肺癌 放射治疗 剂量学 同期加量 

分 类 号：R734.2[医药卫生—肿瘤]