基于RTOG 1005早期乳腺癌调强多目标优化计划和单目标优化计划比较  

Multi-criteria optimization versus single-criteria optimization in intensity-modulated radiotherapy for early breast cancer: a RTOG 1005-based comparison

作　　者：周琼[1] 陈维军[2] 王奇[1] 裘国勤[2] 王健[2] ZHOU Qiong CHEN Weijun WANG Qi QIU Guoqin WANG Jian(Department of Radiation Oncology, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou 310016, China Key Laboratory of Tumor Radiation Therapy/Department of Radiotherapy Physics, Zhejiang Cancer Hospital, Hangzhou 310022, China)

机构地区：[1]浙江大学医学院附属邵逸夫医院放疗科,浙江杭州310016 [2]浙江省肿瘤医院放射物理室/浙江省肿瘤放射治疗重点实验室,浙江杭州310022

出　　处：《中国医学物理学杂志》2017年第10期993-998,共6页Chinese Journal of Medical Physics

摘　　要：目的:基于RTOG 1005报告的评价标准,探讨多目标优化算法(MCO)在早期左侧乳腺癌保乳术后患者静态调强放射治疗(IMRT)计划优化中的可行性及优势。方法:随机抽取12例早期左侧保乳术后的乳腺癌患者,在ADAC Pinnacle v9.2计划系统上,用常规的单目标算法(SCO)的静态调强(IMRT)优化(SCO-IMRT计划),但是都没有完全满足RTOG1005报告的标准。在保持相同的优化参数的条件下,在Ray Station v4.0.3.4-clinical version计划系统上用多目标优化算法(MCO)重新优化计划(MCO-IMRT计划)。比较两套计划的评估靶区(PTVe)和危及器官的剂量学差异。结果:与SCO-IMRT计划相比,MCO-IMRT计划的PTVe95%的处方剂量覆盖度更好(t=2.92,P=0.013),PTVe的高剂量(Dmax)下降54 Gy(t=-2.51,P=0.002),靶区的适形指数稍微差一点(t=-3.19,P=0.004),靶区的均匀性指数相似(t=0.95,P=0.352);心脏V25、V10、Dmean分别降低了23.7%、35.0%、21.1%(t=-2.365,-5.445,-6.140;P<0.05);同侧肺V20、V10、平均剂量分别下降了9.5%、8.9%、4.9%(t=-3.10,-3.05,-3.17;P<0.05),患侧肺的V5下降了6.3%(t=-1.76,P=0.092);对侧肺V5没有明显差别(t=-0.14,P=0.68);对侧乳腺最大剂量降低了50 Gy(t=-2.578,P=0.017),V3.1和平均剂量相似(t=-1.351,-1.285;P=0.191,P=0.212)。结论:与常规调强计划相比,本研究所设计的乳腺癌保乳术后MCO-IMRT计划可显著降低危及器官受照剂量及靶区的高剂量(热点),缩短计划优化时间,但结果还需进一步临床验证。Objective To assess the feasibility and potential dosimetric advantages of multi-criteria optimization（MCO） in intensitymodulated radiotherapy（IMRT） for patients undergoing breast-conserving surgery for early-stage left breast cancer, based on the evaluation standard of RTOG 1005. Methods Twelve patients after breast-conserving surgery for left breast cancer were randomly selected. The plan using single-criteria optimization（SCO） designed in ADAC Pinnacle v9.2 treatment planning system（SCO-IMRT plan） didn＇t completely met the standard of RTOG 1005. Keeping optimization conditions unchanged, IMRT plan re-optimized with MCO was designed in Ray Station v4.0.3.4-clinical version treatment planning system（MCO-IMRT plan）.The dosimetric differences in planning target volume evaluation（PTVe） and organs-at-risk（OAR） were compared between SCOIMRT plan and MCO-IMRT plan. Results Compared with SCO-IMRT plan, MCO-IMRT plan had a higher PTVe 95% prescription dose coverage（t=2.92, P=0.013） and a slightly decreased conformity index of target areas（t=-3.19, P=0.004）. The maximum dose（ Dmax） of PTVe in MCO-IMRT plan was lowered by 54 Gy, compared with that in SCO-IMRT plan（t=-2.51, P=0.02）. No statistical difference was found in homogeneity index of target areas（t=0.95, P=0.352）. Compared with the OAR dose in SCOIMRT plan, the V（20）, V（10） and D（mean）of the heart in MCO-IMRT plan were reduced by about 23.7%, 35.0% and 21.1%, respectively（t=-2.365,-5.445,-6.140; P〈0.05）; the V（20）, V（10）, and D（mean）of the ipsilateral lung were reduced by about 9.5%, 8.9% and 4.9%,respectively（t=-3.10,-3.05,-3.17; P〈0.05）, but the V5 of the ipsilateral lung were reduced by 6.3%（t=-1.76, P=0.092）; the D（max ）of contralateral breast was reduced by 50 Gy（t=-2.58, P =0.017）. The comparison in the V5 of contralateral lung and the V（3.1） and D（mean） of contralateral breast didn＇t showed any statistical differences. Conclusion Compared with conventi

关 键 词：乳腺癌 RTOG 1005 多目标优化 调强放射治疗 放射治疗剂量 

分 类 号：R730.55[医药卫生—肿瘤]