全段食管癌旋转容积调强与固定野静态调强和三维适形放疗计划的剂量学比较  

Dosimetric Comparison of VMAT,IMRT,and 3DCRT for Treatment of Esophagus Cancer

作　　者：梁健[1] 黄思娟[1] 张树芝[2] 李巧巧[1] 胡江[1] 祁振宇[1] 

机构地区：[1]华南肿瘤学国家重点实验室//中山大学肿瘤防治中心放疗科,广东广州510060 [2]深圳市龙岗中心医院,广东深圳518116

出　　处：《中山大学学报（医学科学版）》2016年第4期597-601,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81371710);广东省科技计划项目(2013B021800149)

摘　　要：【目的】通过比较旋转容积调强(VMAT)、静态调强(Step&shoot IMRT)和三维适形放射治疗(3DCRT)技术在全段食管癌的剂量学差异,探讨适于全段食管癌的放射治疗方法。【方法】选取10例晚期全段食管癌患者,分别制定3野(前野+两后斜野或者两前斜野+后野)3DCRT,5野和7野静态IMRT,360°单弧VAMT和部分弧VMAT五种放疗计划。比较不同计划靶区剂量分布、适形度指数(CI)、均匀性指数(HI)以及危及器官受量,筛选出合适的治疗方案。同时记录加速器的总机器跳数(MU)和治疗时间,以评估不同技术的执行效率。【结果】靶区剂量对比显示IMRT和VMAT技术在靶区覆盖率、适形度和剂量分布均匀性方面均优于3DCRT,VMAT主要剂量学指标略优于IMRT。VMAT和IMRT显著降低了脊髓、心脏和双肺V5、V10剂量。与3DCRT和IMRT治疗相比,VMAT治疗时间最短,所需MU最少。【结论】对全段食管癌治疗,VMAT与静态IMRT较传统3DCRT有明显的剂量学优势,尤其是VMAT技术,在满足临床剂量学要求的同时,可以显著缩短治疗时间,有利于减轻治疗中不确定因素的影响及患者的不适。[ Objective ] To explore the suitable way for esophagus cancer radiotherapy by dosimetric comparison of three- dimensional conformal radiotherapy （3DCRT）, intensity modulation radiation therapy （IMRT） and volumetric modulation arc therapy （VMAT）. [Methods] Ten patients with multiple primary cancers of the esophagus were enrolled. 3DCRT, 5-field 1MRT, 7-field IMRT, single arc VMAT and partial-arc VMAT plans were generated for each patient. Conformity index （CI）, heterogeneity index （HI）, dose to organs at risk （OAR）, deliverytime and monitor units （MU） were all recorded as dosimetric indices for plan comparison. [Results] IMRT and VMAT plans were superior to 3D-CRT concerning target coverage, conformity and dose heterogeneity. Both IMRT and VMAT can significantly reduce the maximum radiation dose to the spinal cord and heart, and decrease the low-dose radiation volume V5 and V10 for lung. Compared to IMRT, VMAT requires the shortest delivery time and smallest MU. [ Conclusion ] VMAT can save treatment delivery time while improving the dose distribution for both target and critical structures. It was thus recommended for esophagus cancer radiotherapy.

关 键 词：食管癌 旋转容积调强 静态调强 三维适形放射治疗 

分 类 号：R735.1[医药卫生—肿瘤]