肺部小病灶5野调强、容积调强和陀螺刀疗法的剂量分布比较  

Comparison of dose distribution between 5F-IMRT,VMAT,and Gyro-knife radiotherapy plans for small lung masses

作　　者：王鹏[1] 周解平[2] 詹必红[1] 钱立庭[1] 吴爱东[2] 付杰[3] 

机构地区：[1]安徽省立医院西区放疗科,安徽合肥230022 [2]安徽省立医院西区放疗科放射物理室,安徽合肥230022 [3]上海交通大学附属第六人民医院放射治疗科,上海200233

出　　处：《吉林大学学报（医学版）》2015年第5期1044-1049,共6页Journal of Jilin University：Medicine Edition

基　　金：上海市科学技术委员会科研计划项目资助课题(134119a9300)

摘　　要：目的:比较肺部小病灶5野调强(5F-IMRT)、容积调强(VMAT)和陀螺旋转式60 Co立体定向放射治疗系统(陀螺刀)大分割治疗计划的剂量分布特点,为临床治疗提供理论依据。方法:对16例肺部肿瘤患者设计处方剂量与治疗间隔相似的体部立体定向放射治疗(SBRT)计划,比较3种放疗计划的靶区剂量分布特点、适形度和剂量均匀性以及靶区周边正常肺组织、食管、脊髓的照射剂量。结果:陀螺刀计划的平均计划靶体积(PTV)剂量(PTVDmean)高于5F-IMRT计划(t=23.835,P=0.000)和VMAT计划(t=19.975,P=0.000)。VMAT计划PTV靶区CI值优于5F-IMRT计划(t=3.509,P=0.003),5F-IMRT计划PTV靶区CI值优于陀螺刀计划(t=3.427,P=0.004)。陀螺刀放疗计划PTV靶区HI值大于5F-IMRT计划(t=41.040,P=0.000)和VMAT计划(t=36.780,P=0.000);VMAT计划全肺组织V5低于陀螺刀计划(t=4.303,P=0.000)和5F-IMRT计划(t=5.750,P=0.000);VMAT计划全肺组织V10低于陀螺刀计划(t=5.018,P=0.00);3种计划全肺组织V20和V30比较差异无统计学意义(P>0.05)。VMAT计划全肺平均剂量(MLD)明显低于陀螺刀计划(t=2.462,P=0.027)和5F-IMRT计划(t=3.682,P=0.002)。患侧肺组织比较,陀螺刀计划的V5明显高于5F-IMRT计划(t=5.329,P=0.000)和VMAT计划(t=5.222,P=0.000),陀螺刀计划的V10明显高于5F-IMRT计划(t=4.337,P=0.001)和VMAT(t=4.579,P=0.00)。陀螺刀计划患侧肺的MLD高于5F-IMRT计划(t=4.303,P=0.002)和VMAT计划(t=4.517,P=0.000)。对健侧肺的保护,陀螺刀计划>VMAT计划>5F-IMRT计划。结论:在保证SBRT摆位精度的前提下,陀螺刀计划的主要优势为PTVDmean高,能够在一定程度上保护健侧肺组织;VMAT计划的主要优势为适形度高,能够进行计划验证,全肺(及患侧肺)组织V5、V10和MLD值较低。Objective To compare the dose distribution characteristics between 5intensity modulated radiotherapy（5F-IMRT）,volumetric modulated arc therapy（VMAT）,and Gyro-knife radiotherapy plans for curring the patients with small mass in lung tissue,and to provide the basis for clincal treatmment.Methods Sixteen patients with lung tumor were included in this study.The stereotactic body radiotherapy plans with the same target volume and the prescription dose was used for each patient.The distrubution,target volume rate,dose uniformity,and dose of healty lung tissue,esophagus and spinal cord of 5F-IMRT,VMAT,and Gyroknife treatment plans were compared.Results The PTVDmean of Gyroknife plan was higher than those of 5F-IMRT plan（t=23.835,P=0.000）and VMAT plan（t=19.975,P=0.000）,while the CI of PTV of VMAT plan was superior than that of5F-IMRT plan（t=3.509,P=0.003）and the CI of PTV 5F-IMRT plan was superior than that of Gyroknife plan（t=3.427,P=0.004）.The HI of PTV of VMAT plan was higher than that of Gyroknife plan（t=41.040,P=0.000）and VMAT plan（t=36.780,P=0.000）.The whole lung V5 of VMAT plan was lower than those of Gyroknife plan（t=4.303,P=0.000）and 5F-IMRT plan（t=5.750,P=0.000）,and the whole lung V10 of VMAT plan was lower than that of Gyroknife plan（t=5.018,P=0.000）.The whole lung V20 and V30were simlar among three plans（P〉0.05）.The whole lung mean dose（MLD）of VMAT plan was lower than those of Gyroknife plan（t=2.462,P=0.027）and 5F-IMRT plan（t=3.682,P=0.002）.For the involved lung tissue,the V5 and V10of Gyroknife plan were higher than those of 5F-IMRT plan（t=5.329,P=0.000;t=4.337,P=0.001）and VMAT plan（t=5.222,P=0.000;t=4.579,P=0.000）.The MLD of Gyroknife plan was higher than that of 5F-IMRT plan（t=4.303,P =0.002）and VMAT plan（t=4.517,P =0.000）.The protection abilities of heathy lung was Gyroknife plan〉VMAT plan〉5F-IMRT plan.Conclusion In the premise of SBRT positioning accuracy,the advantages of Gyroknife plan are the higer PTVDmean and the prote

关 键 词：肺肿瘤/放射疗法 治疗计划 5野调强 容积调强 陀螺刀 

分 类 号：R734.2[医药卫生—肿瘤]