鼻咽癌螺旋断层放射治疗过程中实际受照射剂量的研究  

Image- guided determination of actual dose for nasopharyngeal carcinoma patients treated with helical tomotherapy

作　　者：王志强[1] 王志伟[1] 张勇[1] 岳麒[1] 冯旭东[1] 简薇[1] 肖斌[1] 李荣清[1] 

机构地区：[1]昆明医科大学第一附属医院放疗科,昆明市650032

出　　处：《中国肿瘤临床》2017年第3期123-128,共6页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金项目(编号:81560462);云南省自然科学基金面上项目(编号:2016FB150);云南省科技厅"惠民"基金项目(编号:2014RA072)资助~~

摘　　要：目的:通过螺旋断层放射治疗(tomotherapy)系统的自适应模块,分析鼻咽癌患者靶区和危及器官的剂量在治疗过程中与初始计划的差异,为临床提供帮助。方法:回顾性分析2014年2月至2015年2月昆明医科大学第一附属医院运用tomotherapy系统治疗的10例鼻咽癌患者,通过tomotherapy系统中的自适应模块和Mimvista 6.50软件的计算,将初始计划定义为Plan 1;进行图像引导患者总的实际受照射剂量定义为Plan 2。比较两项计划中肿瘤靶区及危及器官的剂量学差异。结果:Plan 2中计划靶区体积(planning gross target volume,PGTV)的D98、D95的剂量较Plan 1分别下降11.91%、6.88%(P=0.001,P=0.006)。Plan 2中左侧腮腺的Dmean、D50较Plan 1分别增加42.23%、63.82%(P<0.001、P=0.001);Plan 2中右侧腮腺的Dmean、D50较Plan 1分别增加38.64%、66.76%(P=0.002,P=0.004)。Plan 2中脊髓的D2剂量较Plan 1也明显增加,增加了16.49%(P=0.026)。结论:鼻咽癌患者在行tomotherapy过程中,非常有必要进一步纠正因解剖结构和摆位所带来的误差,保证放疗计划的精准性。Objective： To determine the law of dose variation in nasopharyngeal carcinoma patients treated with helical tomotherapy by observing the difference between the actual and planned doses of targets and at-risk organs in these patients. Methods： Ten nasopharyngeal carcinoma patients were treated with helical tomotherapy. Each single dose distribution and the corresponding computed tomography （CT） images were transmitted to the commercial software MIMvista 6.50, which was used to perform deformable image registration on the CT images. The sum of the actual dose was then obtained by accumulating the single doses. The image-guided actual dose was denoted as Plan 2, and the initial plan was called Plan 1. The dose-volume histogram of the dose distribution of targets and at-risk organs in Plans i and 2 were compared. Results： The D98 and D95 doses of the planning gross target volume （PGTV） in Plan 2 were significantly lower than those in Plan 1. Compared with Plan 1, the Dmean and D50 doses of double parotids in Plan 2 were higher by 42.23% and 63.82% （P〈0.002, P=0.001） on average, respectively, for the left parotid, as well as by 38.64% and 66.76% （P= 0.002, 0.0044 respectively, for the right parotid. The D2 close of spinal cord in Plan 2 was significantly higher than that in Plan 1. The doses were higher by 16.49% on average （P=0.026）. Conclusion： To achieve precise and individually adaptive radiotherapy, correcting the error between anatomy and placement during tomotherapy for nasopharyngeal carcinoma patients is necessary.

关 键 词：鼻咽癌 自适应放疗 图像引导放射治疗 

分 类 号：R739.63[医药卫生—肿瘤] R730.55[医药卫生—临床医学]