胸中下段食管癌弧内间断出束VMAT计划研究  

A study of finite discontinuity-volumetric modulated arc therapy for mid-and distal-Esophageal Carcinoma

作　　者：王清鑫[1] 江波[1] 孙佳娜[2] 赵路军[1] 袁智勇[1] 徐利明[1] 王伟[1] Wang Qingxin Jiang Bo Sun Jiana Zhao Lujun Yuan Zhiyong Xu Liming Wang Wei(Department of Radiation Oncology, Tianfin Medical University Cancer Institute and Hosptial, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, Chin College of Mathematics and Physics, University of South Chin)

机构地区：[1]天津医科大学肿瘤医院放疗科、国家肿瘤临床医学研究中心天津市“肿瘤防治”重点实验室、天津市恶性肿瘤临床医学研究中心,300060 [2]南华大学数理学院

出　　处：《中华放射肿瘤学杂志》2016年第11期1238-1243,共6页Chinese Journal of Radiation Oncology

基　　金：天津医科大学肿瘤医院药检放专项基金（Y1407）;国家自然科学基金（81201753）

摘　　要：目的：实现Pinnacle计划系统VMAT弧内间断出束的功能，并探究其临床应用优势。方法选取本院8例胸中下段食管癌病例。通过编写的程序实现Pinnacle弧内间断出束的VMAT （ FD.VMAT）。每个病例均设计FD.VMAT、VMAT和固定野IMRT计划。计划评价参数包括PTV的CI、HI、OAR受量、计划验证通过率、机器跳数和治疗时间。配对t检验比较不同计划间差别。结果FD.VMAT计划PTV的CI值和VMAT基本等同（ P＝0.186），HI值略差于VMAT （ P＝0.001），但均优于IMRT计划（P＝0.006、0.002）。 FD.VMAT肺的V20、V30保持了VMAT的优点，比IMRT分别降低19.8％（ P＝0.000）和20.3％（ P＝0.000）；但FD.VMAT肺≤V5具备IMRT的优点，受量低于VMAT，其中V2降低16.8％（ P＝0.000）。 FD.VMAT计划MLD均低于VMAT、IMRT计划（ P＝0.001、0.000）。3种计划的脊髓PRV D1 cm3、心脏V30和计划验证通过率均相近。 FD.VMAT计划心脏V40、Dmean同VMAT计划基本相近（P＝0.175、0.468），略低于IMRT计划（P＝0.021、0.002）。 FD.VMAT计划机器跳数、治疗时间略高于 VMAT 计划，比 IMRT 计划相比分别降低了13.6％、49.6％。结论同 VMAT 和IMRT计划相比，FD.VMAT计划在保证靶区质量、对心脏、脊髓保护和高治疗效率前提下，可进一步降低肺受量，是一种新的可选择的胸中下段食管癌治疗方式。Objective To implement the finite discontinuity.volumetric modulated arc therapy （ FD.VMAT） in the Pinnacle planning system, and to investigate its clinical significance. Methods Eight patients with thoracic esophageal cancer in our hospital were enrolled as subjects. FD.VMAT was fulfilled in the Pinnacle planning system using a developed program. FD.VMAT, VMAT, and fixed.field intensity.modulated radiotherapy （ IMRT ） plans were designed for each patient. The conformity index （ CI ） and homogeneity index （ HI） of the planning target volume （ PTV） ,doses to organs at risk,passing rate for plan verification,number of monitor units,and treatment time were used to evaluate the plans. Comparison between different plans was made by paired t test. Results For the PTV,there was no significant difference in CI between FD.VMAT and VAMT （ P=0.186 ）;FD.VMAT had a significantly worse HI than VMAT （ P=0.001）;however,both the CI and HI were significantly improved in FD.VMAT than in IMRT （ P=0.006, 0.002） . Compared with IMRT, FD.VMAT, retaining the advantage of VMAT, had pulmonary V20 and V30 significantly reduced by 19.79% and 20.32%,respectively （P=0.000,0.000）.For the pulmonary low.dose regions （≤V5 ） ,FD.VMAT retained the advantage of IMRT and had lower doses than VMAT. Particularly, pulmonary V2 was significantly reduced by 16.79%（P=0.000）.The mean lung dose was significantly lowerin FD.VMAT than in VMAT or IMRT （P=0.001,0.000）.There were no significant differences in D1cc to spinal cord PRV,heart V30,or passing rate for plan verification between the three therapies. The heart V40 and mean heart dose in FD.VMAT were similar to those in VMAT （P=0.175,0.468）,but significantly lower than those in IMRT （ P=0.021,0.002） . FD.VMAT had a larger number of monitor units and longer treatment time than VMAT. Compared with IMRT, the number of monitor units and treatment time were reduced by 13.6% and 49.6% in FD.VMAT,respectively. Conclusions Compared with VMAT and IMRT, the a

关 键 词：弧内间断出束容积调强弧形疗法 容积调强弧形疗法 调强放射疗法 Pinnacle计划系统 食管肿瘤 

分 类 号：R735.1[医药卫生—肿瘤]