比较调强放射治疗与三维适形放疗治疗中下段食管癌时心脏和冠状动脉的受量  

Comparison of Heart and Coronary Artery Doses Associated With Intensity-Modulated Radiotherapy Versus Three-Dimensional Conformal Radiotherapy for Distal Esophageal Cancer

作　　者：苏清秀[1] 张矛[1] 金海国[1] 卜明伟 张晶[1] 

机构地区：[1]吉林省肿瘤医院放疗三科,吉林长春130012

出　　处：《中国医学物理学杂志》2014年第5期5139-5143,共5页Chinese Journal of Medical Physics

摘　　要：目的:比较调强放射治疗(IMRT)与三维适形放疗(3D-CRT)治疗中下段食管癌的心脏和冠状动脉的受量。方法:回顾性分析从2011年1月至2012年5月收治的12例中下段食管癌患者,采用Monaco治疗计划系统,所有患者分别制作五野调强放射治疗计划及三野3D-CRT计划,处方剂量均为PTV:60 Gy/30 f。比较五野IMRT和三野3D-CRT计划的DVH、靶区适形度(CI)、心脏,右冠状动脉,左冠状动脉的受量。结果:调强放射治疗计划与3D-CRT计划相比,明显降低了心脏平均剂量(23.01 Gy与28.3 Gy)和V30(24.4%与61.0%),右冠状动脉平均剂量也有显著的降低(平均剂量23.8Gy与35.5 Gy),而左冠状动脉平均剂量没有表现出显着改善(平均剂量11.2Gy与9.2Gy)(p>0.05)。调强放疗显著改善了适形指数。结论:IMRT治疗与3D-CRT相比明显改善了心脏的平均剂量及V30。调强放疗计划与3D-CRT治疗计划相比使心脏V30减少了约40%,同时降低了右冠状动脉受量,这表明调强放射治疗可显着改善放疗诱发的心脏及冠状动脉疾病的风险。调强放疗具有更好的适形度。这将是长期的研究以确定放疗将如何影响冠状动脉心脏疾病的发展和其他心脏并发症。Objective：To compare heart and coronary arteryr adiation exposure using intensity-modulated radiotherapy（IMRT）vs.three-field three-dimensional conformal radiotherapy（3D-CRT） treatment plans for patients with distal esophageal cancer.Methods：Aretrospective analysis was performedon 12 patients of distal esophagus cancers from January 2011 to May 2012,using Monaco treatment planning system.All patients were treated to 60 Gy/30 f with five-field IMRT plans.Theoretical 3D-CRT plans with three-field beam arrangements were generated.Dose volume histograms of the planning target volume,dose conformity,heart,right coronary artery and left coronary artery were compared between the five-field IMRT plans and three-field 3D-CRT plans.Results：Intensity-modulated radiotherapy treatment planning showed significant reduction（p 〈0.05） in heart dose over 3D-CRT as assessed by average mean dose （23.01 vs.28.3 Gy） and V30（24.4% vs.61.0%）.There was also significant sparingofthe right coronaryartery（average mean dose,23.8 Gyvs.35.5 Gy）,whereas the left coronary artery showed no significant improvement（mean dose 11.2 Gy 与 9.2 Gy）（p〉0.05）.Intensity-modulated radiotherapy achieved a significant improvement in target conformity.Conclusions：Our study demonstrated that IMRT treatment planning resulted in significant reduction in mean heart dose and V30 compared with 3D-CRT.Intensity-modulated RT treatment planning resulted in nearly 40% absolute reduction in heart V30 over 3D-CRT treatment planning,and significantly decreases the exposure of the right coronary artery dose.This suggests that the intensity modulated radiation therapy can significantly decreases the risk of radio therapy induced heart and coronary artery disease.Intensity-modulated RT treatment planning also resulted in better dose conformity.Long-term studies are necessary to determine how tradiotherapy will impact on development of coronary artery disease and other cardiac complications.

关 键 词：调强放疗 三维适形放疗 中下段食管癌 心脏 冠状动脉 

分 类 号：R735.1[医药卫生—肿瘤]